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Pediatric head injury

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https://www.readbyqxmd.com/read/29784284/routine-surveillance-imaging-following-mild-traumatic-brain-injury-with-intracranial-hemorrhage-may-not-be-necessary
#1
Smruti K Patel, Yair M Gozal, Bryan M Krueger, James C Bayley, Suzanne Moody, Norberto Andaluz, Richard A Falcone, Karin S Bierbrauer
BACKGROUND: Mild traumatic brain injury (mTBI) comprises the majority of pediatric traumatic brain injury. Children with mTBI even with traumatic intracranial hemorrhage (tICH) rarely experience a clinically significant neurologic decline (CSND). The utility of routine surveillance imaging in the pediatric population also remains controversial, especially owing to concerns about the risks of radiation exposure at a young age. This study aims to identify demographic or injury-related characteristics that may facilitate recognition of children at risk of progression with mTBI...
April 27, 2018: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/29771763/recognizing-diagnosing-and-preventing-child-maltreatment-an-update-for-pediatric-clinicians
#2
Fiona Danaher, Andrea Vandeven, Aine Blanchard, Alice W Newton
PURPOSE OF REVIEW: Despite an increasing understanding of the impact of emotional trauma and physical abuse on children, clinicians and hospitals still sometimes miss the diagnosis of abuse. The literature in 2017 focused on creating standardized approaches to recognition and diagnosis of physical abuse and occult injury, including using the electronic medical record to provide triggers for consultation of the hospital Child Protection Program. The American College of Radiology updated their standardized approach to the evaluation of physical abuse in the child, and other authors gave us screening tools for commercial exploitation, as well as guidance about how to recognize risks for emotional abuse in families...
May 15, 2018: Current Opinion in Pediatrics
https://www.readbyqxmd.com/read/29768294/a-pilot-study-to-reduce-computed-tomography-utilization-for-pediatric-mild-head-injury-in-the-emergency-department-using-a-clinical-decision-support-tool-and-a-structured-parent-discussion-tool
#3
Rakesh S Engineer, Seth R Podolsky, Baruch S Fertel, Purva Grover, Heather Jimenez, Erin L Simon, Courtney M Smalley
INTRODUCTION: The American College of Emergency Physicians embarked on the "Choosing Wisely" campaign to avoid computed tomographic (CT) scans in patients with minor head injury who are at low risk based on validated decision rules. We hypothesized that a Pediatric Mild Head Injury Care Path could be developed and implemented to reduce inappropriate CT utilization with support of a clinical decision support tool (CDST) and a structured parent discussion tool. METHODS: A quality improvement project was initiated for 9 weeks to reduce inappropriate CT utilization through 5 interventions: (1) engagement of leadership, (2) provider education, (3) incorporation of a parent discussion tool to guide discussion during the emergency department (ED) visit between the parent and the provider, (4) CDST embedded in the electronic medical record, and (5) importation of data into the note to drive compliance...
May 15, 2018: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29760839/severely-elevated-blood-pressure-and-early-mortality-in-children-with-traumatic-brain-injuries-the-neglected-end-of-the-spectrum
#4
M Austin Johnson, Matthew A Borgman, Jeremy W Cannon, Nathan Kuppermann, Lucas P Neff
Introduction: In adults with traumatic brain injuries (TBI), hypotension and hypertension at presentation are associated with mortality. The effect of age-adjusted blood pressure in children with TBI has been insufficiently studied. We sought to determine if age-adjusted hypertension in children with severe TBI is associated with mortality. Methods: This was a retrospective analysis of the Department of Defense Trauma Registry (DoDTR) between 2001 and 2013. We included for analysis patients <18 years with severe TBI defined as Abbreviated Injury Severity (AIS) scores of the head ≥3...
May 2018: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29747938/mental-health-after-unintentional-injury-in-a-pediatric-managed-medicaid-population
#5
Kylie M Bushroe, Erinn M Hade, Tara A McCarthy, Jeffrey A Bridge, Julie C Leonard
OBJECTIVES: The purpose of this study was to compare the rates of mental health diagnoses and psychotropic prescriptions pre- and posthospitalization for injury in a managed-Medicaid population. We hypothesized that children have increased rates of mental health diagnoses and psychotropic prescriptions after injury. STUDY DESIGN: We investigated children (n = 2208) ≤18 years of age treated at a pediatric trauma center from 2005 to 2015 who were enrolled in a managed-Medicaid program at hospital admission and for at least 1 healthcare visit in the preceding year...
April 25, 2018: Journal of Pediatrics
https://www.readbyqxmd.com/read/29746363/lower-extremity-fractures-in-hospitalized-pediatric-patients-following-road-traffic-accidents
#6
Shay Tenenbaum, Jason T Bariteau, Ofir Chechik, Adi Givon, Kobi Peleg, Ran Thein
Lower extremity fractures (LEFs) caused by road traffic accidents (RTAs) can result in significant morbidity and account for a substantial part of nonfatal injuries requiring hospitalization. This study investigated the epidemiology of RTA-associated LEFs in the pediatric population. Based on the National Trauma Registry, data of 28,924 RTA hospitalized pediatric patients were reviewed. Data were analyzed according to LEF mechanism of injury, age distribution, fracture types, associated injuries, surgical treatment, and their interrelations...
May 5, 2018: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29739276/corpus-callosum-vasculature-predicts-white-matter-microstructure-abnormalities-following-pediatric-mild-traumatic-brain-injury
#7
Kara M Wendel, Jeong Bin Lee, Bethann Affeldt, Mary Hamer, Indira S Harahap-Carrillo, Andrea C Pardo, Andre Obenaus
Emerging data suggest that pediatric traumatic brain injury (TBI) is associated with impaired developmental plasticity and poorer neuropsychological outcomes than adults with similar head injuries. Unlike adult mild TBI (mTBI), the effects of mTBI on white matter (WM) microstructure and vascular supply are not well-understood in the pediatric population. The cerebral vasculature plays an important role providing necessary nutrients and removing waste. To address this critical element, we examined the microstructure of the corpus callosum (CC) following pediatric mTBI using diffusion tensor imaging (DTI), and investigated myelin, oligodendrocytes, and vasculature of WM with immunohistochemistry...
May 9, 2018: Journal of Neurotrauma
https://www.readbyqxmd.com/read/29738554/repeated-mild-traumatic-brain-injury-can-cause-acute-neurologic-impairment-without-overt-structural-damage-in-juvenile-rats
#8
Alicia Meconi, Ryan C Wortman, David K Wright, Katie J Neale, Melissa Clarkson, Sandy R Shultz, Brian R Christie
Repeated concussion is becoming increasingly recognized as a serious public health concern around the world. Moreover, there is a greater awareness amongst health professionals of the potential for repeated pediatric concussions to detrimentally alter the structure and function of the developing brain. To better study this issue, we developed an awake closed head injury (ACHI) model that enabled repeated concussions to be performed reliably and reproducibly in juvenile rats. A neurological assessment protocol (NAP) score was generated immediately after each ACHI to help quantify the cumulative effects of repeated injury on level of consciousness, and basic motor and reflexive capacity...
2018: PloS One
https://www.readbyqxmd.com/read/29725174/clinico-radiologic-profile-of-pediatric-traumatic-brain-injury-in-western-rajasthan
#9
Pawan Kumar Dara, Manish Parakh, Shyama Choudhary, Hemant Jangid, Priyanka Kumari, Satyendra Khichar
Objective: The aim of this study was to evaluate clinico-radiological profile and outcome of pediatric traumatic brain injury (TBI). Design: Prospective observational study. Setting: Intensive Care Unit, ward and OPD of Pediatrics, Dr. S. N. Medical College, Jodhpur (tertiary care hospital). Participants: A total of 188 children (1 month-18 years) were enrolled and 108 admitted. Intervention: TBI classified as mild, moderate, or severe TBI...
April 2018: Journal of Neurosciences in Rural Practice
https://www.readbyqxmd.com/read/29715216/sports-related-concussions-in-children-differences-in-care-and-expectations-when-seen-in-an-emergency-department-versus-a-sports-medicine-clinic
#10
Kraigher Allan OʼKeefe, Bradley Beamon, Kori L Brewer, Brock Niceler
OBJECTIVES: Patient and parent expectations can potentially influence management of care. We compared expectations in the diagnosis of concussion between patients who presented to a pediatric emergency department (ED) and those who presented to a sports medicine clinic, and if there was a difference in computed tomography (CT) scans performed. METHODS: Head-injured athletes aged 8 to 18 years presenting to a pediatric ED and a sports medicine clinic were enrolled...
May 2018: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29701325/pediatric-maxillofacial-trauma-epidemiologic-study-between-the-years-2012-2015-in-israeli-medical-center
#11
Michael Joachim, Moti Tuizer, Shareef Araidy, Imad Abu El-Naaj
BACKGROUND/AIM: Trauma is the leading cause of morbidity and mortality in the pediatric population worldwide, and Israel is no different in this aspect. Of these injuries, craniofacial trauma is a significant cause of morbidity in the pediatric population. The high occurrence of pediatric trauma is possibly related to a lower perception for the hazards that surround them, combined with the restless and adventurous nature that is typical of children. The aim was to perform a retrospective, epidemiological study on facial trauma in children examined in the emergency room in order to analyze the different patterns in pediatric maxillofacial trauma, to emphasize this data and educate those involved in preventing and treating children's injuries...
April 27, 2018: Dental Traumatology: Official Publication of International Association for Dental Traumatology
https://www.readbyqxmd.com/read/29700200/external-validation-of-the-pedibirn-clinical-prediction-rule-for-abusive-head-trauma
#12
Helena Pfeiffer, Anne Smith, Alison Mary Kemp, Laura Elizabeth Cowley, John A Cheek, Stuart R Dalziel, Meredith L Borland, Sharon O'Brien, Megan Bonisch, Jocelyn Neutze, Ed Oakley, Louise Crowe, Stephen J C Hearps, Mark D Lyttle, Silvia Bressan, Franz E Babl
BACKGROUND AND OBJECTIVES: A 4-variable abusive head trauma (AHT) clinical prediction rule (CPR) for use in the PICU was derived and validated for children <3 years of age by the Pediatric Brain Injury Research Network (PediBIRN). We aimed to externally validate PediBIRN as designed (PICU only) as well as using broader inclusion criteria (admitted children with head injuries). METHODS: This was a secondary analysis of a prospective multicenter study of pediatric head injuries at 5 Australian and New Zealand tertiary pediatric centers...
April 26, 2018: Pediatrics
https://www.readbyqxmd.com/read/29698343/the-effect-of-an-observation-unit-on-pediatric-minor-head-injury
#13
Yusuke Hagiwara, Nobuaki Inoue
OBJECTIVE: The aim of this study was to evaluate the effect of an observation unit (OU) in an emergency department on reducing unnecessary use of computed tomography (CT) for minor blunt head trauma. METHODS: This study was a retrospective before-and-after study of pediatric patients 18 years or younger with minor blunt head trauma. Patients with a Glasgow Coma Scale score of 14 or 15 who presented to the emergency department were included in the analysis. The rates of head CT use in the period before and after the institution of the OU were compared...
April 24, 2018: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29698292/does-the-watson-jones-or-modified-smith-petersen-approach-provide-superior-exposure-for-femoral-neck-fracture-fixation
#14
Paul M Lichstein, John P Kleimeyer, Michael Githens, John S Vorhies, Michael J Gardner, Michael Bellino, Julius Bishop
BACKGROUND: A well-reduced femoral neck fracture is more likely to heal than a poorly reduced one, and increasing the quality of the surgical exposure makes it easier to achieve anatomic fracture reduction. Two open approaches are in common use for femoral neck fractures, the modified Smith-Petersen and Watson-Jones; however, to our knowledge, the quality of exposure of the femoral neck exposure provided by each approach has not been investigated. QUESTIONS/PURPOSES: (1) What is the respective area of exposed femoral neck afforded by the Watson-Jones and modified Smith-Petersen approaches? (2) Is there a difference in the ability to visualize and/or palpate important anatomic landmarks provided by the Watson-Jones and modified Smith-Petersen approaches? METHODS: Ten fresh-frozen human pelvi underwent both modified Smith-Petersen (utilizing the caudal extent of the standard Smith-Petersen interval distal to the anterosuperior iliac spine and parallel to the palpable interval between the tensor fascia lata and the sartorius) and Watson-Jones approaches...
April 24, 2018: Clinical Orthopaedics and related Research
https://www.readbyqxmd.com/read/29694653/clinical-factors-predictive-of-traumatic-brain-injuries-in-case-of-mild-traumatic-brain-injury-in-children-case-control-study
#15
Widad Gueddari, Amine Ouardi, Sanaa Talbi, Sihem Salam, Abdelhadi Zineddine
BACKGROUND: Mild head injury (MHI) is very common in children and the problem is a lack of consensus criteria for the indication of a brain CT. OBJECTIVE: To determine predictors of cranio-cerebral lesions (CCL) in the case of MHI in children. METHODS: Case-control study over a period of 3 years. Included children aged 1 month to 15 years, were those admitted to the department of Pediatric Emergencies for MHI and had performed a brain CT. The principal outcome was the presence of traumatic brain injury...
July 2017: La Tunisie Médicale
https://www.readbyqxmd.com/read/29683858/the-effect-of-booster-seat-use-on-pediatric-injuries-in-motor-vehicle-frontal-crashes
#16
Sean Caskey, Joshua Hammond, Jeffery Peck, Matthew Sardelli, Theresa Atkinson
BACKGROUND: Motor vehicle crashes are a significant source of pediatric mortality and morbidity. Studies indicate that booster seats significantly improve seat belt fit for children who have not attained a height of 145 cm (4' 9"). This study examined injuries occurring in booster age children up to age 12, as the majority of children do not attain 145 cm until this age. The purpose of the study was to identify differences in injuries due to the type of restraint used, with attention to musculoskeletal injuries...
April 20, 2018: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/29675071/pediatric-head-injury-a-study-of-403-cases-in-a-tertiary-care-hospital-in-a-developing-country
#17
Abrar Ahad Wani, Arif Hussain Sarmast, Muzaffar Ahangar, Nayil Khursheed Malik, Sarabjit Singh Chhibber, Sajad Hussain Arif, Altaf Umar Ramzan, Bashir Ahmed Dar, Zulfiqar Ali
Introduction: Traumatic brain injury (TBI) in children is a significant cause of morbidity and mortality worldwide. Falls are the most common type of injury, followed by motor vehicle-related accidents and child abuse. Aims and Objectives: The aim and objective of this study was to elucidate the various modes of injury, prognostic factors, complications, incidence of various modes of injury, and outcome in TBI in pediatric population. Materials and Methods: Patients with TBI, 18 years or less in age, managed in our Department of Neurosurgery, over a period of 2 years, were studied prospectively...
October 2017: Journal of Pediatric Neurosciences
https://www.readbyqxmd.com/read/29674994/a-cross-sectional-study-on-cerebral-hemodynamics-after-mild-traumatic-brain-injury-in-a-pediatric-population
#18
Corey M Thibeault, Samuel Thorpe, Michael J O'Brien, Nicolas Canac, Mina Ranjbaran, Ilyas Patanam, Artin Sarraf, James LeVangie, Fabien Scalzo, Seth J Wilk, Ramon Diaz-Arrastia, Robert B Hamilton
The microvasculature is prominently affected by traumatic brain injury (TBI), including mild TBI (concussion). Assessment of cerebral hemodynamics shows promise as biomarkers of TBI, and may help inform development of therapies aimed at promoting neurologic recovery. The objective of this study was to assess the evolution in cerebral hemodynamics observable with transcranial Doppler (TCD) ultrasound in subjects suffering from a concussion at different intervals during recovery. Pediatric subjects between the ages of 14 and 19 years clinically diagnosed with a concussion were observed at different points post-injury...
2018: Frontiers in Neurology
https://www.readbyqxmd.com/read/29672322/isolated-traumatic-diastasis-of-the-clival-synchondroses-without-clival-fracture
#19
Amir H Faraji, Pawel G Ochalski, Alp Ozpinar, Jason E Blatt, Ian F Pollack
Traumatic clival fractures in the pediatric population are associated with high mortality rates. In our previously reported series, a subset of clival fractures were associated with traumatic diastasis of the surrounding clival synchondroses. Herein, we describe a pediatric case of an isolated traumatic diastasis of the clival synchondroses without clival fracture with significant injury to neurovascular structures. To our knowledge this is the first report to describe this entity. Careful radiological attention should be made towards the clival synchondroses in crushing head injuries to best tailor screening for cerebrovascular injury even in the absence of clival fractures...
April 19, 2018: Pediatric Neurosurgery
https://www.readbyqxmd.com/read/29665151/validation-of-the-pediatric-nexus-ii-head-ct-decision-instrument-for-selective-imaging-of-pediatric-patients-with-blunt-head-trauma
#20
Malkeet Gupta, William R Mower, Robert M Rodriguez, Gregory W Hendey
BACKGROUND: Data suggests that clinicians, when evaluating pediatric patients with blunt head trauma, may be over-ordering head computed tomography. Prior decision instruments aimed at aiding clinicians in safely forgoing CTs may be paradoxically increasing CT utilization. This study evaluated a novel decision instrument that aims for high sensitivity while also improving specificity over prior instruments. METHODS: We conducted a planned secondary analysis of the NEXUS Head CT decision instrument (DI) among patients less than 18 years old...
April 17, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
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