Injuries In Pediatric Population Research Articles

Initial CT Imaging Predicts Mortality in Severe Traumatic Brain Injuries in Pediatric Population-A Systematic Review and Meta-Analysis.

The purpose of this systematic review was to analyze evidence based on existing studies on the ability of initial CT imaging to predict mortality in severe traumatic brain injuries (TBIs) in pediatric patients. An experienced librarian searched for all existing studies based on the inclusion and exclusion criteria. The studies were screened by two blinded reviewers. Of the 3277 studies included in the search, data on prevalence of imaging findings and mortality rate could only be extracted from 22 studies. A few of those studies had patient-specific data relating specific imaging findings to outcome, allowing the data analysis, calculation of the area under the curve (AUC) and receiver operating characteristic (ROC), and generation of a forest plot for each finding. The data were extracted to calculate the sensitivity (SN), specificity (SP), positive predictive value (PPV), negative predicted value (NPV), AUC, and ROC for extradural hematoma (EDH), subdural hematoma (SDH), traumatic subarachnoid hemorrhage (tSAH), skull fractures, and edema. There were a total of 2219 patients, 747 females and 1461 males. Of the total, 564 patients died and 1651 survived; 293 patients had SDH, 76 had EDH, 347 had tSAH, 244 had skull fractures, and 416 had edema. The studies included had high bias and lower grade of evidence. Out of the different CT scan findings, brain edema had the highest SN, PPV, NPV, and AUC. EDH had the highest SP to predict in-hospital mortality.

Prevalence of Facial Injuries in Pediatric Population: A Cross Sectional Study from Pakistan

Background: Road traffic accidents are the leading cause of death for children in Pakistan. This is particularly true in the country of Pakistan (RTA). Implementing safety measures such as car seats, limiting the ages of drivers in the family, and prohibiting children from riding bikes and driving cars can help prevent childhood accidents or minimise the severity of those injuries that do occur. It is difficult to appreciate the entire severity of the problem since there is a paucity of published research on the epidemiology of face injuries in children. This makes it difficult to invest in programmes that prevent injuries that are detrimental to the public's health. Objective: To provide a description of the epidemiology of face injuries sustained by children who were hospitalized to the hospital as a result of RTA. Duration of Study: March 2019 to March 2020 Place of Study: Allama iqbal memorial teaching hospital Khawaja Muhammad Safdar medical college Design: Cross Sectional Patients and Methods: We gathered information on all patients younger than 16 years old who were admitted to the hospital as a result of RTA between the years 2019 and 2020. The patients were all younger than 16 years old. Comparisons were done across a broad spectrum of characteristics, such as the presence or absence of Facial Injuries and age groups, amongst others. Main Outcome Measures: facial injuries. Sample Size: 220 patients. Result: As a result of their injuries, 74 (34%) of the population that was affected suffered from some form of brain impairment, and 78 (35.6%) suffered from some form of face injury. There were thirteen children (9.1% of the total population) operating the vehicle when it was involved in the accident. It was discovered that 53.8% of the children were not wearing any kind of seatbelt or other kid safety gear while they were riding in the back seats of the car and they were under age while riding a bike. Conclusion: It should not come as a surprise that facial injuries are so prevalent in our society today. In addition, the study found that teenage driving is more prevalent than was previously believed, which calls for ongoing monitoring as well as the development of suitable treatments. Increased documentation of the use of restraints and stronger enforcement of safety laws by police can both play a substantial role in reducing the number of injuries that are associated with the use of restraints. The findings of the study highlight the necessity of combination seating or rear seating in addition to restraints that are appropriate for the child's age in order to reduce the likelihood that youngsters would sustain injuries to their heads or faces.

Outcomes of Conservative Management of Fingertip Injury in Paediatric Population

In infants and children, the fingertip injuries occur frequently by accident which result causing infliction which ranges from a little cut to a fracture and also the finger amputation thus requires an immediate treatment intervention to avoid deformities. Different therapeutic approaches have been used involving surgical or conservative treatment. The conservative treatment is considered to be superior choice for management of these injuries so this research was designed to evaluate the functional and aesthetic outcomes of conservative approaches for treating fingertip injuries. Methods: This research consists of 30 children admitted to Ziaudin Hospital, Karachi with Allen's type II and III of fingertip injuries divided into three groups based on the treatment approach including Platelet Gel treatment group (group I), Fucidic acid treatment group (group II), Hyaluronic acid treatment group (group III). Results: All the conservative treatment approaches showed promising improvement regarding the range of motion, healing time, aesthetic and sensory outcome, complications, and subjective satisfaction. However, the platelet gel group exhibits significantly short healing time (p=0.003) in comparison to Fucidic acid and Hyaluronic acid treatment group Conclusion: It was concluded that conservative treatment is one of the effective approach in management of fingertip injuries in paediatric population providing better functional, sensory and aesthetic outcomes. Keywords: Fingertip injuries, Conservative treatment, Outcomes

Incidence of AKI after burn injury in pediatric population

Incidence of AKI after burn injury in pediatric population

P.117 Initial imaging predicts mortality in severe traumatic brain injuries in pediatric population - a systematic review and meta-analysis

Background: The purpose of this systematic review was to synthesize evidence based on existing studies on the ability of initial imaging to predict mortality in severe traumatic brain injuries (TBIs) in pediatric patients. Methods: An experienced librarian searched for all existing studies based on the inclusion and exclusion criteria. The studies were screened by two blinded reviewers. The data was extracted to calculate the sensitivity (SN), specificity (SP), positive predictive value (PPV), negative predicted value (NPV), area under the curve (AUC), and receiver operating characteristic (ROC) for extradural hematoma (EDH), subdural hematoma (SDH), traumatic subarachnoid hemorrhage (tSAH), skull fractures, and edema. Results: Of the 3277 studies included in the search, data could only be extracted from 22 studies. There were a total of 2219 patients, 747 females, and 1461 males. 564 patients died and 1651 survived. 293 patients had SDH, 76 had EDH, 347 had tSAH, 244 had skull fractures, and 416 had edema. Seven of the studies had sufficient data to calculate the AUC, ROC, and generate a forest plot for the imaging findings. Conclusions: Out of the different CT scan findings, brain edema had the highest SN, PPV, NPV, and AUC. EDH had the highest SP to predict in hospital mortality.

Animal bite injuries in pediatric population: a systematic review

Objectives: To assess the scientific literature pertaining the risk factors for injuries among victims of animal bite injuries. Data and sources: A systematic review of scientific literature published until May 2020 was carried out in the following databases: PubMed, Cochrane Library, Google Scholar and Journals@ovid. Study selection: A total of 924 records were found, of which 29 articles fulfilled the inclusion criteria and were analyzed. There was a male preponderance in most of the studies with male/female ratio ranging from 0.75:1 to 2.1:1. The age range varies from 0 to 19 years with the mean age varying from 3.6 to 8 years. Pitbulls, Rottweiler's, German shepherds, Bull terriers, Labradors and Dobermans were breeds with higher risk of attack. The animals were familiar to the victim (own, friends, neighbors) in 27–98% instances. Most cases of animal bite injuries were recorded during Summer and Spring months. Head and neck followed by extremities was found to be most inflicted area. Conclusions: The sociodemographic characteristics of victim as well as the biting animal affect the circumstances leading to biting episode. However, the results should be interpreted with caution due to the high heterogeneity among studies and moderate quality evidence.

A prospective study of surgical management in fracture of both bone forearm shaft using titanium elastic nailing system in pediatric patients

Introduction: Both bone forearm fractures are common orthopaedic injuries in pediatric population which present significant challenges to the orthopaedic community. It is not only important to treat them adequately but also to recognize the overall impact a fracture can have on a child, possibly limiting physical activity. Forearm fractures comprise 40% or more of pediatric fractures.Majority of these fractures can be treated conservatively with closed reduction and cast immobilization. A recognized failure rate has been reported up to 7% to 32%. Commonly two operative treatment modalities are employed at present: open compression plating and flexible intramedullary nailing. Each modality has advantage and disadvantage. Objective: Assess the functional outcome and complications associated with Titanium Elastic Nailing System in fracture of both bone forearm in pediatric patients.Materials and Methods: 20 Patients with both bone forearm shaft fracture aged between 6-16 years admitted to Chigateri General Hospital and Bapuji Hospital attached to J.J.M. Medical College Davanagere in the period from September 2019 to August 2021.Results: In our study, majority of the patients were boys, with an average age of 10.5 years with mid 1/3rd shaft transverse fractures being the most common, and self-fall while playing was the most common mode of injury. The surgery required minimum dissection, short operation time with hardly any risks of intraoperative complications. The average fracture union time was 9 weeks with patients recovering near normal functions of forearm at the earliest.We didn’t encounter any major post-operative complications in our study, and 95% of the patients had excellent range of motion at wrist, elbow and radio-ulnar joints and 5% had satisfactory range of motion.Conclusion: TENS nailing in both bone forearm shaft fractures in pediatric age group provides excellent results with advantages of early union, excellent recovery of function, minimal invasive and decreased time of surgery.

Road accidents in children involving light electric vehicles cause more severe injuries than other similar vehicles

Road accidents in Israel were responsible for 23% of injuries in pediatric population between 2013 and 2017. In recent years, the massive entrance of e-bike and other light electric vehicles (called collectively LEV) into the roads is significantly changing the epidemiology of road accidents among children. The study aims to describe the causes, injury types, and other epidemiological characteristics of children injured in road accident and compare injuries of LEV to regular bicycles and other light non-electric vehicles (called collectively LNEV). This retrospective study included all referrals to pediatric emergency department due to road accidents, from April 2015 through March 2017. The details of the accidents and injuries were retrieved, and the subjects' characteristics were compared based on vehicle type. A total of 1531 children met the inclusion criteria. The study found that LEV road accidents among children cause more severe injuries than other LNEV in terms of injury severity score (ISS) (mean ISS 5.8 ± 4.9 vs. 4.7 ± 3.6, P = 0.001), head and neck injuries (18.7% vs. 12.9%, respectively, P < 0.05), lower extremities (36.5% vs. 23.9%, P = 0.001), and multisystem injuries (58.6% vs. 31.8%, P < 0.001). The findings of the current study suggest that the use of LEVs is changing the epidemiology of road accidents, which requires adjustments in accident and injury prevention strategies.Conclusion: The study results should encourage authorities to provide appropriate community-based programs to promote helmet use, introduce mandatory training and licensing program for LEV riders, and enhance enforcement. What is Known: • Road accidents are the leading cause of death among children and young adults (5 to 29 years). • In recent years, there is a massive entrance of e-bikes and other light electric vehicles on the roads. What is New: • LEV (light electric vehicle) accidents among children impose more severe injuries than other LNEVs (light non-electric vehicles) in terms of ISS, hospitalizations, and multisystem injuries. • The use of LEV is changing the epidemiology of road accidents. This change requires enhancing accident and injury prevention strategies.

Arrow-Shot Injury to Pediatric Spinal Cord

AbstractPenetrating spinal cord injuries (PSCI) in cervical region are extremely rare in pediatric population. Most injuries in pediatric population are accidental due to gunshot or a stab injury with a sharp or pointed object. Gun shots may result into a severe wound which is usually fatal and may result in death, quadriplegia, or serious long-term disability. Stab injuries are less severe and may result in neurological sequalae. In this paper, an unusual case of pediatric arrow shot partial cervical cord injury is reported which was managed by aggressive neurosurgical management. The arrow lodged in the cervical cord was very near to the vertebral artery leading to parapariesis which recovered well without any complications. Diagnostic imaging at admission included radiographs, computed tomography (CT), and CT angiography of the cervical region. The patient underwent early surgical intervention with removal of foreign body from the cord and subsequent dural suturing.

Treadmill Hand Injuries Among Children: A Retrospective Case Series From Hospitalized Patients.

Background: With the progress of modernization, treadmill hand injury in pediatric population is taking on a global trend in recent years. The purpose of this study was to investigate the epidemiology and clinical features in a developing country, thereby providing some experience in the treatment and prevention of this particular type of injury.Methods: A 5-year retrospective review of patients with treadmill hand injury in Burn and Plastic Surgery ward at Children' Hospital of Chongqing Medical University was conducted. Demographics, injury details, therapy performed, length of hospital stay, complications, and outcome were analyzed.Results: Forty-six patients were surveyed, with a mean age of 3.5 ± 2.0 years old, including 24 males and 22 females. Injuries (77.8%) occurred between dinner to bedtime, and 95.7% happened indoors. Fingers were the most vulnerable part, of which the middle finger, ring finger, and index finger were the top three ones. The mean body surface area (BSA%) was 0.3 ± 0.2, but at least in deep dermal. Dressing changes, full-thickness skin grafts (FTSG), and Negative Pleasure Wound Therapy (NPWT) assisted FTSG were performed. The scar contracture, as the most severe complication, occurred in 26 patients, of which 22 originally received dressing changes at the time of injury.Conclusion: Treadmill hand injury in children should be highly regarded. Compared with conservative dressing changes, surgical intervention from a professional team may achieve more satisfactory prognosis and fewer complications. A prevention strategy based on “Time-Space-Person” was summarized according to its epidemiological characteristics, may help to decrease the incidence of this specific type of injury theoretically.

Conservative management of mandibular fracture with maxillomandibular fixation using orthodontic brackets and elastics: A case report

Mandibular fracture is the most common facial skeletal injury in pediatric population seen in hospital setting. Fracture management is complicated by the developing permanent tooth buds and continuous mandibular growth. However, healing capacity in children is faster. Hence, conservative management is most often the treatment of choice for bone fractures in children. This case report is about a 6-year-old female child who sustained mandibular fracture after a road traffic accident (RTA) which was conservatively managed with maxillomandibular fixation using brackets and elastics. Orthodontic brackets were placed on facial aspect of posterior teeth of both the arches and elastics were used for traction leading to immobilization and stabilization of fracture. Healing was uneventful with complete bony union as evident by three months follow up orthopantomogram. Maxillomandibular fixation using brackets and elastics is a simple and non-invasive closed fracture reduction technique giving excellent result. The present case report showed successful outcome of mandibular fracture management.

Pressure Injury.

Pressure injury is seen across all healthcare settings and affects people of any age and health condition. It imposes a significant burden, with annual costs of up to $17.8 billion in the United States alone. Despite considerable resources it exhausts, the disease remains very prevalent, and the incidence is on the rise. This is in part due to aging population, growing number of nursing home residents, poorly understood biology, and dismal track record of clinical research in this field. In our Review Article, we discuss the disease pathophysiology, clinical manifestation, evidence based recommendations for risk assessment, prevention and timely management, existing challenges, and directions to improve research on the field. This article encompasses dedicated sections on the full spectrum of the pressure related pathologies including "conventional pressure ulcers", "medical device related pressure injuries", "pressure injuries in mucosal membranes", "pressure injuries in pediatric population", "pressure injury at end of life", and the "role of pressure in pathogenesis of diabetic foot ulcers".

Effect of 632 nm He-Ne Laser on Gram-Positive Bacteria in Deep Partial Thickness Pediatric Burn: A Prospective Double-Blind Randomized Controlled Trial

Background. Burns are one of the most common injuries in pediatric population, gram-positive bacteria is the main pathogens responsible for wound infection that is the leading cause of morbidity and sometimes mortality in growing children with burn. Low level laser is a new treatment option that is increasingly used in the field of wound healing. Aim. To investigate the effect of He-Ne laser on gram-positive bacteria and healing time of deep second-degree pediatric burn. Methods. Thirty children of both genders aged from 2 to 9 years old with 2nd degree upper limb burn infected with gram-positive bacteria participated in this study. They were randomly assigned into two equal groups; either the control group (group A) received systematic antibiotic and 10 minutes’ placebo laser light, or the laser group (group B) received 632 nm laser light, 6 J/cm2 scanning technique for 10 minutes. All patients received regular wound care (dressing). The study protocol was once a day, 3 times / week for one month. Pre and post-treatment evaluation of wound culture and the healing time was recorded for both groups. Results. Wound culture of all children in both groups were negative after two weeks of the study and wound healing time was significantly shorter in the laser group (14.6±5.7 days) than the control group (27±7.3 days). Conclusion. He-Ne laser is an effective option of treatment for 2nd-degree pediatric burn as it has a bactericidal effect on gram-positive bacteria and accelerates wound healing process significantly.

Epidemiological and Clinico-radiological Evaluation of Head Injury in Pediatric Population.

ABSTRACTBackground:Head injury in infancy and childhood has been documented as the single most common cause of death. In India, children aged <15 years constitute 35% of the total population and contribute to 20–30% of all head injuries. In this study, we attempted to analyze the epidemiological factors, management, and outcome of traumatic brain injury (TBI). The objective of this study were to find the causes of head injury in children and its pattern of distribution in this population and to analyze the efforts required to prevent the injury and management focusing on limiting the progression of primary brain injury and minimizing secondary brain insult.Results:A total of 2714 patients with head injury were admitted at our hospital during the study period and, out of them, 508 (18.17%) were pediatric patients with age less than 18 years. Of the 508 patients, only 497 patients were included in this study. In the present study, 357 (71.83%) were males and 140 (28.16%) were females. In total, 351 cases were managed conservatively whereas surgical intervention was conducted in 146 cases (P < 0.001). In this study, the most common mode of injury was a road traffic accident (RTA) (46.88%; n=233), followed by fall from height (34.8%; n=173) (P < 0.001). It was also seen that epidural hematoma and fracture hematoma were the most common computed tomography findings in pediatric patients with head injury followed by parenchymal contusion or contusion with or without fracture followed by diffuse axonal injury. A total of 344 cases out of 497 cases were discharged with Glasgow outcome score (GOS)-5 whereas nine cases remained in a persistent vegetative state (GOS-2).Conclusion:Early intervention aimed at the primary lesion in TBI in children generally carries a good outcome, and limits as much as possible the ongoing biomechanical, physiological, and pathological sequelae post-TBI. In teenagers, the importance of proper self-care along with adequate safety gears while doing any TBI-prone activity should be emphasized.

The incidence of paediatric ACL injury is increasing in Finland

PurposeAnterior cruciate ligament (ACL) injury is a common knee injury in paediatric and adolescent patients. The population-based incidence of paediatric ACL injury is, however, unknown. Recent studies suggest increased ACL injury rates among adolescents, especially in active, sports-participating population. The purpose of this study was to investigate the population-based incidence rates of ACL injuries and trends in paediatric ACL reconstruction surgery.MethodAll ACL injuries were identified (ICD-10 diagnosis code S83.5) leading to hospitalisation or surgery using validated Finnish National Hospital Discharge Register (NHDR) data from 1997 to 2014. The sample comprised 19,961,205 Finnish residents aged less than 18 years at the time of injury. Hospital admissions with the diagnosis code S83.5 were analysed more thoroughly including, sex, age and the need for surgical interventions.ResultsDuring the 18-year study period, 4725 subjects of the study population had sustained an ACL injury. The total ACL injury incidence in study population was 23.3 per 100,000 person-years. The median age of the patients at the time of injury was 16 years (range 4–17). The incidence of ACL injury increased with age, and the highest incidence was observed among 17-year old (113.5 per 100,000 person-years). Incidence rate did not differ between genders. From the total ACL injury population of 4725 hospitalisations, 3168 (67.0%) underwent ACL reconstruction, of which 2988 (94.3%) were treated with arthroscopic reconstruction and 180 (5.6%) with open surgery. In addition, 1557 (33.0%) were treated non-operatively without ACL reconstruction. The annual incidence of ACL injuries in the Finnish paediatric population has increased during the past 15 years. The lowest incidence rate was seen in 1999 (incidence of 17.7 per 100,000 person-years, 195 ACL injuries) and the highest in 2011 (incidence of 31.5 per 100,000 person-years, 346 ACL injuries). The highest increase in ACL injuries was seen in girls aged 13–15 years, with an increase of 143%.ConclusionACL injury is not a negligible knee injury in the paediatric population. The incidence of paediatric ACL injury has increased during the past 15 years. Moreover, a twofold increase in incidence of paediatric ACL injury was noted during the last 10 years of the study period. Incidence rates among male and female paediatric patients were comparable.Level of evidenceIII.

E-bike-related cranial injuries in pediatric population.

E-bikes are being used increasingly by all age groups. Children riding e-bikes often do not use safety equipment such as helmets, and are at increased risk for injuries requiring neurosurgery. The most common type of injury among pediatric e-bikers is head and neck trauma. We describe our experience treating cranial injuries. Data regarding children (< 18years old) with e-bike-related cranial injuries were collected retrospectively from two tertiary centers. Twenty patients were included. Seventeen were e-bike users, and three were hit as pedestrians. The average age at admission was 11.3 ± 4.85 (range 1.5-17) years old. All 17 e-bike users did not wear a helmet. Seventeen of the 20 (85%) suffered from skull fractures (70% involving the frontal bone), nine involving more than one region. Six patients (30%) had intracerebral contusions, 3 (15%) an epidural hematoma, and 6 (30%) a subdural hematoma. Three patients (15%) underwent surgery, two of them for depressed skull fracture reduction, and one for insertion of intracranial pressure monitor. One patient died (5%); 1 (5%) had a Glasgow Outcome Scale (GOS) of 3, 5 (25%) had a GOS of 2, and 13 (65%) were discharged without any neurological deficit (GOS 1). E-bikes may inflict various cranial injuries, including fractures and intracranial bleeds, and may lead to significant morbidity and mortality. Education of children to use protective gear, wide exposure of younger adolescents to traffic laws, and limiting the use of e-bikes to older children, are all necessary actions.

Trends in pediatric cervical spine injuries in the United States in a 10-year period.

Cervical spine fractures (CSFs) are potentially devastating injuries in pediatric population. Fortunately, these injuries are uncommon in pediatric patients. The purpose of this study was to determine the epidemiology, the risk factors, mechanisms of injury and to identify possible strategies for prevention. In addition, the aim of the current study was to compare CSF sustained in 2003 to CSF sustained in 2008 and 2013 so as to recognize the trend of pediatric CSFs in the United States. The National Electronic Injury Surveillance System was queried for CSF sustained in pediatric population up to 16 years of age for years 2003, 2008, and 2013. Outcomes of interest were patient characteristics (age and sex), causes of CSF, and mechanism of injury. Eighty pediatric patients with CSF were identified. The average age was 10.5 years. Boys sustained significantly more CSF than girls. Statistically significant more CSF were occurred in children of 10-16 years than in children up to 9 years. Sports or recreational activities and home-related accidents were the predominant causes of CSF. Mechanisms of injury were age-related, with younger children sustaining CSF as a result of home-related accidents while adolescents commonly injured during sporting or recreational activities. In contrast to current data in literature, motor vehicle accidents were not a major cause of CSF. Comparing the years 2003, 2008, and 2013, statistically significant differences in the incidence of CSF were not found. Our study confirms previous findings that adolescents who sustain CSF have higher incidence of sport or recreation-related accidents than younger patients who sustain commonly home-related accidents as a consequence of insufficient parental supervision. The perception that motor vehicle accidents comprise major cause of CSF appears not to be true.

Epidemiology of Pediatric Musculoskeletal Injuries and Their Pattern in a Tertiary Care Center of North India.

Background:Trauma is emerging as an epidemic and a leading cause of morbidity and mortality in children. Children <15 years of age comprise about 32.8% or about 1/3rd of the total Indian population. In India, up to one fourth of hospital admissions and approximately 15% of deaths in children are due to injury. This study presents the epidemiology, various causes and pattern of musculoskeletal injuries in pediatric population of North India.Materials and Methods:This is an observational, prospective hospital-based study conducted in a tertiary care center of North India for 6 months from July to December 2016. All pediatric patients in the age group 0-15 years who presented to the orthopedic emergency and out patient department with a history of trauma were included in the study.Results:Children aged 6-15 years (58%) suffered more injuries than children under 5 years of age (42%). Male pediatric population (58.5%) had more musculoskeletal injuries as compared to female pediatric population of the same age group (41.5%) in both the groups. Urban pediatric population (68.78%) suffered more injuries as compared to rural population of the same age group. Right extremities were more commonly involved in both the age groups. Upper limb injuries (50.59% in 0-5 years age group and 47.42% in 6- 15 years age group) were most common followed by lower limb and pelvic injuries. Very few (2.9% in 0- 5 years age group and 4.8% in 6-15 years age group) patients sustained isolated spinal injuries. Out of the 3712 patients 59.40% of patients had a history of fall, followed by road traffic accident related injuries (32%). The most common injuries were superficial injuries i.e., abrasions and bruises. The second most common injury was cut or open wounds mostly seen on hand, forearm and legs.Conclusion:The high incidence of pediatric trauma on roads and falls indicates the need for more supervision during playing and identification of specific risk factors for these injuries in our setting. Injuries in pediatric age group by and large is a preventable condition. Therefore, injury prevention in children should be a priority.

Le fratture sovracondiloidee dell’omero in età pediatrica

Supracondylar humeral fracture is the most common elbow injury in pediatric population. According to the mechanism of injury, these fractures can be divided in two subgroups: extension type and flexion type. Undisplaced and slightly displaced fractures can be treated conservatively. Displaced fractures require reduction followed by percutaneous pinning. Several complications could occur in association with a supracondylar humeral fracture. Early complications include neuro-vascular injury and compartment syndrome, delayed complications include cubitus varus, joint stiffness and malunion.

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.