Pediatric Head Research Articles

Paediatric Head and Neck Hemangiomas: Scopes, Challenges and Outcome of Surgical Management

Paediatric Head and Neck Hemangiomas: Scopes, Challenges and Outcome of Surgical Management

Comparative Study on Different Clinical Decision-Making Tools in Pediatric Head Injury Cases

Objective: To carry out a comparative study on effective clinical decision-making tools between Canadian Assessment of Tomography for Childhood Head injury, Pediatric Emergency Care Applied Research Network (PECARN) and Children's Head injury Algorithm for the prediction of Important Clinical Events in pediatrics head trauma cases. Study Design: Validation study. Place and Duration of Study: Department of Surgery, Saif Shaheed Hospital, Haveli Kahota, Azad Kashmir, Pakistan, from Oct 2021 to Nov 2022. Methodology: One hundred and fifty paediatric patients suffering from minor head injury were evaluated on clinical intervention decisions as per emergency procedures during the period of study. Sensitivity, Specificity, Positive Predictive Value and Negative Predictive Value of the selected diagnostic tests was checked. Results: Based on the head CT positivity, PECARN was found to be 81.8% sensitive and 61.9% specific. Canadian Assessment of Tomography for Childhood show sensitivity of 90.9 % and specificity of 65.5%. CHALICE had sensitivity and specificity of 63.6% and 61.5% respectively. CHALICE was unable to identify a pathological CT result with statistical significance (p=0.17) however PECARN and CATCH rule proved significant (p<0.05). CATCH rule show highest positive predictive score of 17.2% and negative predictive score of 98.8%. Conclusion: PECARN, CATCH, and CHALICE criteria are effective in deciding whether or not to perform Computerized Brain Tomography (CBT) scans on children with MHT, leading us to believe that employing these criteria could prevent unnecessary CBT scans.

Neurological symptoms in pediatric abusive head trauma: Multi-center data for clinical forensic medicine

Central nervous system-associated lesions can frequently be found in abusive head trauma (AHT) cases. Since there are frequently no visible signs of injury on the body surface, the diagnosis of AHT can be challenging. In particular, if the affected child shows only isolated neurological symptoms, these are often misinterpreted as a minor illness. Using a retrospective study design at three university hospitals, 72 medico-legal cases of “shaken baby syndrome” – a common variant of AHT – were analyzed. A comparison between confession cases (n=15) and non-confession cases was used in order to reduce the risk of circular reasoning. The most common neurological symptoms in the present cases were: epileptic seizures (44 %), pallor (37 %), somnolence (31 %), reduced muscle tone (25 %), vomiting (20 %) and unconsciousness (15 %). There were also no statistically significant differences between confession and non-confession cases, nor when comparing the simultaneous presence of skin or skeletal lesions. The combination of several symptoms serves as an indicator for the presence of AHT and should lead to further diagnostic measures under the hypothesis of the presence of an AHT in clinical observation.

Temporal development of subdural collections in infants with confessed abusive head trauma: a forensic neuroimaging study.

Estimating the age of injury in pediatric abusive head trauma (AHT) is a challenging task but potentially valuable for the identification of perpetrators. The aims of the study are (1) to describe the temporal development of different imaging features of subdural collections (SDCs), and (2) to provide novel age-diagnostic reference data for forensic-radiological expert reports. Using a multi-center approach and a 10-year study period, serial neuroimaging studies of 13 comprehensively investigated AHT cases (8 CT and 26 MRI scans) were analyzed regarding several subdural imaging parameters (SDC appearances, entities, components, and associated findings). Due to confessions by perpetrators, the time points of the trauma were presumed unique and known in all cases facilitating correlation of imaging findings with time. Hyperdense SDCs in CT were found up to 9 d post-injury (p.i.), CSF-like SDCs in CT or MRI as early as from the 3rd hour p.i., and subdural membrane formation as late as from day 283. The heterogeneous variant of the subdural hematohygroma was observed to be the dominant SDC entity between 3 h and 22 d p.i. The tadpole sign was detected in MRI between 3 h and 46 d p.i. Certain subdural imaging findings may be helpful for estimating the age of injury in AHT. Subdural membrane formation is demonstrated to be a late finding and the tadpole sign is an early phenomenon p.i. The data corroborated that the sediment but not the supernatant has the potential for being valuable for age-diagnostic aspects. Question Reliable evidence-based data on the development of SDCs is sparse but required for expert opinions on pediatric AHT. Findings Reference data on the evolution of the imaging appearance of SDCs and associated phenomena in confirmed cases of AHT are provided. Clinical relevance As there is a great need for estimating the age of injury in criminal and civil proceedings, many clinical radiologists are confronted with the diagnostic and forensic aspects of AHT that are addressed in the present study.

Mandibular Defects and Reconstruction Post Oncological Resection in Paediatric Patients

Introduction: Tumours of the paediatric mandible are rare clinical entities, which require a multidisciplinary team management. Surgery is frequently utilized as a modality for local control in the management of paediatric mandibular neoplasms. However, mandibular reconstruction in such age group is more challenging than in their adult counterparts, owing to the developing nature of the mandible and the craniofacial skeleton. Materials & Methods: The medical records of patients below the age of 18 years of age presented to the Paediatric Oncology and Head and Neck Surgical Oncology Departments at the National Cancer Institute of Cairo University from January 2014 to January 2024 with mandibular tumour were reviewed. The review includes; radiological site of the lesion, histo-pathological diagnosis, multidisciplinary team management. Patients that underwent segmental mandibular resection were evaluated for the type of the resultant mandibular defects according to Brown’s classification of mandibular defects and the subsequent reconstruction procedures. Results: Forty-two patients were reported with mandibular neoplasm. Primary mandibular tumours were found in 35 cases (83.3%), of which non odontogenic tumours were diagnosed in 29 cases (69.0%). The anatomical subunits of the mandible; ramus, angle and body were involved in 14 (33.3%), 13 (31.0%) and 15 (35.7%) cases, respectively. Twenty-nine patients underwent segmental mandibular resection. According to Brown’s classification; Class I, Class Ic, Class II, Class IIc, Class III, Class IV and Class IVc were the resultant defects in 0 (0%), 2 (6.9%), 10 (35.5%), 10 (35.5%), 3 (10.3%), 0 (0%), and 4 (13.8%) cases, respectively. Conclusion: The different pathologies of the mandibular neoplasms affecting the paediatric age group frequently involve the ramus of the mandible. With the surgery being the modality of choice in most of such pathologies, the resultant defects following segmental resection and the reconstruction approach in such age group vary greatly from the adult age group. Hence, the free fibular bone segments used for restoration of the ramus projection would be of a relatively larger length. Condylar resection, unfortunately, would hinder the restoration of occlusion relationship, essential for normal development of the maxillofacial skeleton.

From age-specific to size-specific dose protocol for paediatric head computed tomography: a simple practical strategy for necessity assessment and parameter setting.

This study proposes a practical approach to assessing the need for and determining the transitioning parameters from age-specific to size-specific dose protocols in paediatric head computed tomography examinations. It was designed to begin with the two different age-specific protocols currently applied on paediatric patients of 1 y≤age≤6 y (21.34mGy) and those of age>6 y (34.73mGy). One characteristic size (HDthreshold) was found by measuring anteroposterior head diameter on historical topograms and used with age to set 135 cases into four groups for investigation (A, ≤6y, ≤HDthreshold; B, ≤6y, >HDthreshold; C, >6y, ≤HDthreshold; and D, >6 y, >HDthreshold). The image quality was compared in both subjective and objective manners. Results suggest patients in Group C may have received a potential overdose (38%), while the exposure setting for Group D may replace that for B. The proposed strategy was sufficient to assess the necessity and determine the transitioning parameters from age- to size-specific dose protocols.

Pediatric non-nasopharyngeal head and neck squamous cell carcinoma: Analysis of the Surveillance, Epidemiology, and End Results (SEER) program with review of the literature

BackgroundDespite its prevalence in adults, head and neck squamous cell carcinoma (HNSCC) is considered a rare entity in pediatrics where lymphomas, neural tumors, and soft tissue sarcomas predominate in the head and neck. Given the association of squamous cell carcinoma with the human papillomavirus, a risk factor that may be present from birth, and the difficulties in staging this disease for prognostication in children, it is important to revisit nationally collected data for prevalence and outcomes assessments. ObjectiveTo examine a publicly available national database to describe the incidence, pathology, treatment, and survival of pediatric HNSCC. To review the available literature regarding management, outcomes, and risk factors for this disease process. MethodsThe National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) tumor database was queried to identify pediatric subjects ages 0 to 19 diagnosed HNSCC between 1973 and 2019. ResultsTwo-hundred ninety-two cases were identified. Subjects were 62.7 % male (n = 183) and the average age was 15.4 years (range 2–19, median 16). Subjects were 65.8 % white (n = 192), 22.9 % black (n = 67), 8.9 % Asian/Pacific Islander (n = 26), 1 % American Indian (n = 3), and 1.4 % unknown (n = 4). The most common primary sites were nasopharynx (45.9 %), oral cavity (30.5 %), larynx (8.6 %), salivary gland (4.1 %), nasal cavity & paranasal sinus (3.4 %), and lip (2.7 %). There was no statistically significant difference between primary subsite and age, race, histologic grade, or extent of disease. The 5-year overall survival was 83.6 %. DiscussionHead and neck squamous cell carcinoma is more likely to present in older children and is more prevalent in White populations. The nasopharynx is the most common subsite involved, which differs from adult populations in which non-nasopharyngeal subsites including the larynx, oral cavity, and oropharynx are most frequently affected. ConclusionHead and neck squamous cell carcinoma is rare in pediatric patients but should not be overlooked by physicians in the differential diagnosis, particularly in teenagers. Further study is needed to determine whether this represents a unique entity or can be staged and treated according to adult guidelines.

Nontraumatic Pediatric Head and Neck Emergencies: Resource for On-Call Radiologists.

The vast array of acute nontraumatic diseases encountered in the head and neck of pediatric patients can be intimidating for radiologists in training in a fast-paced emergency setting. Although there is some overlap of pediatric and adult diseases, congenital lesions and developmental variants are much more common in the pediatric population. Furthermore, the relative incidences of numerous infections and neoplasms differ between pediatric and adult populations. Young patients and/or those with developmental delays may have clinical histories that are difficult to elicit or nonspecific presentations, underscoring the importance of imaging in facilitating accurate and timely diagnoses. It is essential that radiologists caring for children be well versed in pediatric nontraumatic head and neck emergency imaging. The authors provide an on-call resource for radiology trainees, organized by anatomic location and highlighting key points, pearls, pitfalls, and mimics of many acute nontraumatic diseases in the pediatric head and neck. ©RSNA, 2024 Supplemental material is available for this article.

Pediatric Head Injuries Occur During the Play Childhood Period of 3-6 Years: A Sample from the South of Türkiye

Aim: Pediatric head traumas (HT) are of significant concern due to their potential for high mortality rates, which are influenced by the clinical progression of traumatic brain injury (TBI). HT poses a substantial risk of morbidity and mortality across all pediatric age groups, underscoring the importance of effective clinical management and follow-up procedures. The current study aims to evaluate the epidemiology, causes, and clinical outcomes of head injuries during childhood play between the ages of 3 and 6. Material and Method: Focused on pediatric patients aged 3-6 years who were admitted to the emergency department (ED) for HT, and required consultation from a neurosurgeon. Data collected included patients’ demographics, trauma etiology, cranial examination findings, laboratory results upon admission, cranial computed tomography findings, classification of TBI, treatment administered, and clinical progression. Results: The median Glasgow Coma Scale (GCS) scores were found to be significantly lower in the group with intraparenchymal injury compared to the group without intraparenchymal injury (p=0.008). The group with intraparenchymal injury exhibited a higher than expected occurrence of moderate TBI (p=0.012). Females exhibited significantly lower mean rank scores for age compared to males (p=0.032). Patients hospitalized for HT had significantly lower GCS scores than those discharged (p=0.001). There is a higher prevalence of moderate TBI than expected in the group of hospitalized patients (p=0.008). The mortality rate among hospitalized patients was 5.6%, with lower GCS scores and hyperglycemia upon admission significantly associated with fatalities (p=0.015, p=0.045). Conclusion: Identification and management of moderate TBI are imperative in children presenting to the ED with HT during early childhood play. Children with intraparenchymal injury should be hospitalized. Additionally, hyperglycemia in pediatric HT patients may signify high-energy trauma.

Pediatric head and neck emergencies.

Head and neck emergencies in children are frequent cause of visits to the hospital. Imaging plays a critical role in the management of these patients. This review article aims to familiarize radiologists with the common clinical presentations encountered, imaging characteristics of nontraumatic pediatric head and neck emergencies, and improve their ability to recognize associated complications as well as be aware of common mimics. We researched our database for commonly encountered nontraumatic head and neck emergencies in children. A literature search was done to compare and complete the list of conditions to be discussed in this review. The review was organized according to anatomical location of the emergent condition. Relevant anatomy has been discussed along with clinical presentation, imaging characteristics and complications. We have presented common mimics with each set of disorders. Key imaging characteristics have been delineated using radiology images. Familiarity with the known complications of head and neck emergencies allows the radiologist to actively search for such findings, encourage early institution of appropriate therapy, and improve outcomes.

A Study of Skeletal Survey Disparity in Pediatric Head Injury in the Emergency Department.

The objective of this study was to evaluate disparities in skeletal survey (SS) use for pediatric. head injury patients in the emergency department (ED). This was a multi-site retrospective. cohort study of children <24months with concern for head injury and injury on head CT from. 7/1/12 - 1/1/22. We determined adjusted associations between SS completion and race, ethnicity, language for care, insurance type, and income, with sub-analysis of children <6months and with complex injury. We evaluated occult fracture prevalence. Two-hundred seventy children met criteria and 88 had SS. No statistical association was found between skeletal survey completion and race or ethnicity, language for care, private insurance, median census tract income, or in sub-analyses. Two of 88 (2.3%) patients had occult fracture; both had risk factors for NAT. In conclusion, no statistical association was found between SS completion and demographics. Occult fracture was uncommon. SS use can likely be decreased in lower risk patients.

A multicentre observational study of paediatric head and neck abscesses

IntroductionIn winter of 2022/3 paediatric ENT surgeons across the UK observed that the incidence of severe abscesses in the head and neck and associated complications was higher than seen in previous years. We aimed to collate and evaluate data from across the UK to establish if this was a true rise in cases, and to describe the factors associated. MethodsA multicentre retrospective data collection was undertaken from 13 units across the UK. Patients admitted between September 2022–February 2023 with a head and neck abscess including sinogenic, otogenic, deep and superficial neck abscesses were included. Demographic, disease specific, management and outcome data were collected. Hospital episode statistic data were also requested and analysed to allow for comparison with previous 10 years of head and neck abscesses. Results262 patients with abscesses of the head and neck were admitted during the study period, 100 between September and November and 163 between December and February. Mastoid abscesses were the most common abscess across both groups. The rate of group A streptococcus + culture results rose significantly from 12 % in autumn group to 30 % in winter (p = 0.02). The rate of intracranial complications rose from 10 % to 18 % (p = 0.11) and the rate of venous thrombosis rose over the same timeframe from 3 % to 14 % (p = 0.01). DiscussionThis study demonstrated a statistically significant rise in the rate of group A streptococcus associated abscesses when comparing Autumn and Winter 2022/2023. Over the same timeframe a statistically significant rise in the proportion of patients with venous thromboses associated with H&N abscesses was noted. Interestingly, despite perceived national consensus regarding a spike in abscess incidence, the number of abscesses seen in winter 2022/2023 was in keeping with expected rates of paediatric H&N abscesses, based on pre covid year-on-year rise in incidence.

Pediatric Desmoid Tumor of the Head and Neck: A Systematic Review and Modified Framework for Management by Age Group.

Unlike in adults, pediatric head and neck desmoid tumors (DTs) have greater capacity to interfere with normal anatomical development. Therefore, adequate interventions and management must be defined. We aimed to provide the most comprehensive systematic review on pediatric head and neck DTs to date, including assessment of lesion location predominance, intervention, and management, and examination of any associations between age and outcomes like surgical margin status, recurrence, and complications. A systematic literature review was conducted between January 1990 and December 2023 using PubMed, Scopus, and MEDLINE databases following the Preferred Reporting Items for Systematic Review and Meta-Analyses 2020 guidelines. We aimed to elucidate intervention and management strategies by studying various outcomes in 0-11 and 12-21 year olds. The literature search yielded 44 studies, totaling 121 patients. Most head and neck DTs localized to the mandible, cranium, and neck; occurred early (P = 4.18 years); and underwent local resection with positive margins. Older and younger patients shared no difference in complication or recurrence rates. We found recurrence is likely to occur with positive margins. Because standard treatment of DTs is surgical resection with negative margins, if technically feasible with reasonable associated morbidity, we suggest additional resection of the tumor to achieve negative margins. We also recommend more robust follow-up data collection, not only due to desmoid's high recurrence and data paucity in patients older than 12 years, but also, to better establish best management practices.

Assessing the influence of dose modulation on water equivalent diameter estimation in pediatric head CT imaging

Pediatric head computed tomography (CT) scans necessitate precise determination of radiation dose to optimize image quality while minimizing patient exposure. This study explores the influence of head size variation on radiation dose and image quality using phantom and patients set, aiming to investigate the efficacy of Automatic Exposure Control (AEC) in dose modulation. Image noise and radiation dose were assessed using with and without AEC, maintaining a constant tube current of 180 mA. The correlation between CT dose index volume (CTDIvol) and water-equivalent diameter (Dw) was examined across 134 image sets, revealing an exponential relationship indicative of AEC's contribution to elevated radiation exposure in larger heads. Furthermore, a slice-based analysis demonstrated a consistent variation in tube current along the slice location, effectively modulated by Dw. However, discrepancies in tube current were observed in the caudal region, suggesting the influence of factors beyond section size. Refinement of analysis improved curve fitting, highlighting the importance of section size in dose modulation. AEC proved essential in maintaining image quality consistency across slices, with inactive AEC resulting in lower image noise in cranial slices. These findings highlight the significance of AEC-based dose modulation in pediatric head CT to ensure optimal image quality while minimizing radiation exposure, emphasizing the need for comprehensive understanding and implementation of AEC systems from different manufacturers.

Outcomes of head trauma in children admitted to a tertiary paediatric intensive care unit in South Wales

Objective This study aimed to evaluate the demographics and outcomes of major paediatric head trauma managed in our Paediatric Intensive Care Unit (PICU) in South Wales and comparison is made with the existing published literature. Design and setting A retrospective review of medical records and imaging of patients identified from the paediatric neurosurgical trauma database at University Hospital Wales (UHW) from March 2013 to July 2021. We assessed the GCS at admission, mechanism of injury, CT scan, type of surgery required and GOS after 12 months. Patients A total of 46 children (<16 years old) who were admitted to intensive care secondary to a traumatic brain injury were identified. Mean age was 7.6 years (range 0 days–15.7 years). Results Road traffic accidents (RTA) were the predominant mechanism of injury (56.5%), followed by falls (32.6%). Neurosurgical intervention, including stand-alone ICP monitoring was required in 69.6% of patients. Post discharge outcome was defined using the Glasgow Outcome Score (GOS), with a good functional outcome (GOS ≥4) accounting for 86.4% at 12 months follow-up. Survival rate was 93.4%. Conclusion Demographics in South Wales are similar to the published literature, except falls had a higher mortality than RTA in our cohort. Head injury mechanisms, surgical interventions and outcomes show variation between patients from the pre-covid and lockdown periods. Outcomes are good for surgically and conservatively treated patients and very comparable to the published literature.

Pediatric head injury guideline use in Sweden: a cross-sectional survey on determinants for successful implementation of a clinical practice guideline

BackgroundThe Scandinavian Neurotrauma Committee guideline (SNC-16) was developed and published in 2016, to aid clinicians in management of pediatric head injuries in Scandinavian emergency departments (ED). The objective of this study was to explore determinants for use of the SNC-16 guideline by Swedish ED physicians.MethodsThis is a nationwide, cross-sectional, web-based survey in Sweden. Using modified snowball sampling, physicians managing children in the ED were invited via e-mail to complete the validated Clinician Guideline Determinants Questionnaire between February and May, 2023. Baseline data, data on enablers and barriers for use of the SNC-16 guideline, and preferred routes for implementation and access of guidelines in general were collected and analyzed descriptively and exploratory with Chi-square and Fisher's tests.ResultsOf 595 invitations, 198 emergency physicians completed the survey (effective response rate 33.3%). There was a high reported use of the SNC-16 guideline (149/195; 76.4%) and a strong belief in its benefits for the patients (188/197; 95.4% agreement). Respondents generally agreed with the guideline's content (187/197; 94.9%) and found it easy to use and navigate (188/197; 95.4%). Some respondents (53/197; 26.9%) perceived a lack of organizational support needed to use the guideline. Implementation tools may be improved as only 58.9% (116/197) agreed that the guideline includes such. Only 37.6% (74/197) of the respondents agreed that the guideline clearly describes the underlying evidence supporting the recommendation. Most respondents prefer to consult colleagues (178/198; 89.9%) and guidelines (149/198; 75.3%) to gain knowledge to guide clinical decision making. Four types of enablers for guideline use emerged from free-text answers: ease of use and implementation, alignment with local guidelines and practice, advantages for stakeholders, and practicality and accessibility. Barriers for guideline use were manifested as: organizational challenges, medical concerns, and practical concerns.ConclusionsThe findings suggest high self-reported use of the SNC-16 guideline among Swedish ED physicians. In updated versions of the guideline, focus on improving implementation tools and descriptions of the underlying evidence may further facilitate adoption and adherence. Measures to improve organizational support for guideline use and involvement of patient representatives should also be considered.

3D printed heterogeneous paediatric head and adult thorax phantoms for linear accelerator radiotherapy quality assurance: from fabrication to treatment delivery.

This study aims to design and fabricate a 3D printed heterogeneous paediatric head phantom and to customize a thorax phantom for radiotherapy dosimetry. &#xD;Approach: This study designed, fabricated, and tested 3D printed radiotherapy phantoms that can simulate soft tissue, lung, brain, and bone. Various polymers were considered in designing the phantoms. Polylactic acid+, nylon, and plaster were used in simulating different tissue equivalence. Dimensional accuracy, and CT number were investigated. The phantoms were subjected to a complete radiotherapy clinical workflow. Several treatment plans were delivered in both the head and the thorax phantom from a simple single 6 MV beam, parallel opposed beams, and five-field intensity modulated radiotherapy (IMRT) beams. Dose measurements using an ionization chamber and radiochromic films were compared with the calculated doses of the Varian Eclipse treatment planning system (TPS). &#xD;Main results: The fabricated heterogeneous phantoms represent paediatric human head and adult thorax based on its radiation attenuation and anatomy. The measured CT number ranges are within -786.23 ± 10.55, 0.98 ± 3.86, 129.51 ± 12.83, and 651.14 ± 47.76 HU for lung, water/brain, soft tissue, and bone, respectively. It has a good radiological imaging visual similarity relative to a real human head and thorax depicting soft tissue, lung, bone, and brain. The accumulated dose readings for both conformal radiotherapy and IMRT match with the TPS calculated dose within ±2% and ±4% for head and thorax phantom, respectively. The mean pass rate for all the plans delivered are above 90% for gamma analysis criterion of 3% / 3 mm.&#xD;Significance and conclusion: The fabricated heterogeneous paediatric head and thorax phantoms are useful in Linac end-to-end radiotherapy quality assurance based on its CT image and measured radiation dose. The manufacturing and dosimetry workflow of this study can be utilized by other institutions for dosimetry and trainings. &#xD.

Pleomorphic adenoma in an adolescent, about a clinical case

Introduction: salivary gland tumors in children represent a low percentage of pediatric head and neck tumors; most of them are diagnosed in association with the Parotid salivary gland and present a higher proportion of malignancy than in adults. Objective: to present a case with a diagnosis of Pleomorphic Adenoma: clinical symptoms, complementary examinations, treatment and evolution. Case presentation: female patient, 13 years old, from a rural background and white race, attended the Maxillofacial Surgery consultation, in good general condition, accompanied by her parents, due to an increase in volume of a hard consistency, not fixed to deep planes ( mobile), asymptomatic, of 7 months of evolution and 3 cm in length located in the left parotid region. Ultrasound of soft tissues and neck was indicated, as well as contrast-enhanced facial mass tomography, which showed a mass in relation to the left parotid gland that captured contrast. In addition, complementary examinations and a fine needle aspiration biopsy (FNAB) were performed, resulting in a benign parotid gland tumor (Pleomorphic Adenoma). Superficial parotidectomy was performed with preservation of the facial nerve. The patient progressed satisfactorily and continues to be followed up by consultation. Conclusions: pleomorphic adenomas are discovered in practice as slowly growing asymptomatic masses; the size is variable and will always depend on the stage at which it is detected.

Pediatric head and neck trauma in the United States: Trends, risk factors and outcomes using the National Trauma Data Bank.

Pediatric head and neck (HN) trauma is an important contributor to pediatric morbidity, resulting in significant downstream consequences. Few studies provide epidemiological predictors of pediatric HN trauma on a national scale. The present study aims to identify risk factors of HN injury and mortality in the pediatric population. A retrospective cohort study was conducted for patients (age <18 years) using the US National Trauma Data Bank (NTDB 2007-2019). Demographic, injury, and physiologic outcome data were analyzed. HN injury was defined as a head or neck Abbreviated Injury Scale (AIS) >0. Logistic regression identified independent predictors of mortality following HN trauma. Of the 1.42 million pediatric patients analyzed, 44.05% had HN injury. In patients aged 0-4, the most common mechanism was falls (47.67% in this age group) while in ages 14-17, motor vehicle/transport accidents (MVTs) were the most common mechanism (56.06%). Controlling for demographics, comorbidities, and injury severity, HN injury was associated with increased odds of mortality (OR 2.404, 95% CI 1.530-3.778). HN injury mortality was strongly predicted by firearm exposure (OR 11.28, 95% CI 6.074-20.95), age <4 (OR 1.179, 95% CI 1.071-1.299), and self-insured status (OR 1.977, 95% CI 1.811-2.157). NTDB data demonstrate that the percentage of pediatric patients with HN trauma has decreased over the past 12 years although is associated with increased odds of mortality. Age and insurance status predicted mortality from HN trauma, with falls and MVTs being the most common mechanisms of injury. These data have implications for future public health efforts in this patient population. 3.

Kapanji Technique in Pediatric Head and Neck Radius Fractures

Kapanji Technique in Pediatric Head and Neck Radius Fractures