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Head trauma in pediatric patients

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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/29760839/severely-elevated-blood-pressure-and-early-mortality-in-children-with-traumatic-brain-injuries-the-neglected-end-of-the-spectrum
#2
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/29746363/lower-extremity-fractures-in-hospitalized-pediatric-patients-following-road-traffic-accidents
#3
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/29729014/revision-cochlear-implant-surgery-in-children-surgical-and-audiological-outcomes
#4
Jeffrey Yeung, Amanda Griffin, Stephen Newton, Margaret Kenna, Greg R Licameli
OBJECTIVES/HYPOTHESIS: To determine the incidence of cochlear implant failure and to examine surgical and audiological outcomes. STUDY DESIGN: Retrospective review, case series. METHODS: This study sought indications for revision surgery, surgical findings, and outcomes, and audiological outcomes in pediatric cochlear implant patients. Pre- and postcochlear reimplantation word recognition performance was analyzed using a modified version of the Pediatric Ranked Order Speech Perception (PROSPER) score...
May 4, 2018: Laryngoscope
https://www.readbyqxmd.com/read/29718002/vertebral-artery-dissection-masquerading-as-concussion-in-an-adolescent
#5
Gogi Kumar, Bryan Ludwig, Vipul V Patel
OBJECTIVE: Educate providers about the clinical presentation and consequences of delaying diagnosis of traumatic vertebral artery dissection with thromboembolic ischemic strokes in the pediatric population. Vertebral artery dissection is often difficult to diagnose and can be a potentially devastating cause of ischemic stroke. METHODS: Review of the chart, peer review/discussion, and imaging interpretation. RESULTS: A 16-year-old boy was admitted with confusion after a head and neck trauma was sustained while wrestling...
May 2018: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29717350/pediatric-intracranial-aneurysms-changes-from-previous-studies
#6
Ruiqi Chen, Si Zhang, Chao You, Rui Guo, Lu Ma
PURPOSE: To develop a better understanding of pediatric intracranial aneurysms (PIAs). METHODS: All PIAs treated in our center from January 2012 to April 2017 were retrospectively included. Clinical data, treatment summaries, and follow-up outcomes were retrieved and analyzed. RESULTS: A total of 66 PIAs were found in 64 patients with a mean age of 11.4 ± 5.7 years, 68.8% of whom were male. The most common symptoms were seizure (n = 7, 63...
May 2, 2018: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
https://www.readbyqxmd.com/read/29701325/pediatric-maxillofacial-trauma-epidemiologic-study-between-the-years-2012-2015-in-israeli-medical-center
#7
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
#8
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/29698347/trends-in-imaging-findings-interventions-and-outcomes-among-children-with-isolated-head-trauma
#9
Eric R Coon, Thomas B Newman, Matt Hall, Jacob Wilkes, Susan L Bratton, Alan R Schroeder
OBJECTIVE: The aim was to analyze the impact of decreased head computed tomography (CT) imaging on detection of abnormalities and outcomes for children with isolated head trauma. METHODS: The study involves a multicenter retrospective cohort of patients younger than 19 years presenting for isolated head trauma to emergency departments in the Pediatric Health Information System database from 2003 to 2015. Patients directly admitted or transferred to another facility and those with a discharge diagnosis code for child maltreatment were excluded...
April 24, 2018: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29698343/the-effect-of-an-observation-unit-on-pediatric-minor-head-injury
#10
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/29665151/validation-of-the-pediatric-nexus-ii-head-ct-decision-instrument-for-selective-imaging-of-pediatric-patients-with-blunt-head-trauma
#11
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
https://www.readbyqxmd.com/read/29659947/pediatric-thoracic-trauma-in-iraq-and-afghanistan
#12
Ryan J Keneally, Cynthia H Shields, Albert Hsu, Howard I Prior, Kevin M Creamer
Introduction: The objective of this study is to review available data on pediatric thoracic trauma seen at U.S. military treatment facilities in Iraq and Afghanistan and describe the scope of injuries, patterns seen, and associated mortality. The results were compared with adults injured in Iraq and Afghanistan and other reports of pediatric thoracic trauma in the literature. Materials and Methods: The investigators received approval from the Uniformed Services University of the Health Sciences' institutional review board before the study...
April 6, 2018: Military Medicine
https://www.readbyqxmd.com/read/29622334/pediatric-major-head-injury-not-a-minor-problem
#13
REVIEW
Aaron N Leetch, Bryan Wilson
Traumatic brain injury is a highly prevalent and devastating cause of morbidity and mortality in children. A rapid, stepwise approach to the traumatized child should proceed, addressing life-threatening problems first. Management focuses on preventing secondary injury from physiologic extremes such as hypoxemia, hypotension, prolonged hyperventilation, temperature extremes, and rapid changes in cerebral blood flow. Initial Glasgow Coma Score, hyperglycemia, and imaging are often prognostic of outcome. Surgically amenable lesions should be evacuated promptly...
May 2018: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/29606408/racial-and-ethnic-disparities-and-bias-in-the-evaluation-and-reporting-of-abusive-head-trauma
#14
Kent P Hymel, Antoinette L Laskey, Kathryn R Crowell, Ming Wang, Veronica Armijo-Garcia, Terra N Frazier, Kelly S Tieves, Robin Foster, Kerri Weeks
OBJECTIVE: To characterize racial and ethnic disparities in the evaluation and reporting of suspected abusive head trauma (AHT) across the 18 participating sites of the Pediatric Brain Injury Research Network (PediBIRN). We hypothesized that such disparities would be confirmed at multiple sites and occur more frequently in patients with a lower risk for AHT. STUDY DESIGN: Aggregate and site-specific analysis of the cross-sectional PediBIRN dataset, comparing AHT evaluation and reporting frequencies in subpopulations of white/non-Hispanic and minority race/ethnicity patients with lower vs higher risk for AHT...
March 29, 2018: Journal of Pediatrics
https://www.readbyqxmd.com/read/29589453/-multidisciplinary-approach-to-surgical-disorders-of-the-pancreas-in-children
#15
J Šnajdauf, M Rygl, O Petrů, B Frýbová, J Náhlovský, V Mixa, R Keil, J Bronský, M Kynčl, R Kodet
INTRODUCTION: Surgical diseases of the pancreas in children are not common and may be associated with significant morbidity and potential mortality. A multidisciplinary approach is essential for correct diagnosis, surgical strategy and postoperative as well as follow-up care. METHOD: Retrospective analysis of patients operated on due to a pathological lesion of the pancreas focused on diagnostics, operating procedures, postoperative complications, and long-term results...
2018: Rozhledy V Chirurgii: Měsíčník Československé Chirurgické Společnosti
https://www.readbyqxmd.com/read/29580346/head-ct-before-transfer-does-not-decrease-time-to-craniotomy-for-tbi-patients
#16
Peter M Tonui, Sarah K Spilman, Carlos A Pelaez, Mark R Mankins, Richard A Sidwell
Rural trauma education emphasizes that radiologic imaging should be discouraged if it delays transfer to definitive care. With increased capacity for image sharing, however, radiography obtained at referring hospitals (RH) could help providers at trauma centers (TC) prepare for patients with traumatic brain injury. We evaluated whether a head CT prior to transfer accelerated time to neurosurgical intervention at the TC. The study was conducted at a combined adult Level I and pediatric Level II TC with a catchment area that includes rural hospitals within a 150 mile radius...
February 1, 2018: American Surgeon
https://www.readbyqxmd.com/read/29555324/plasma-d-dimer-safely-reduces-unnecessary-ct-scans-obtained-in-the-evaluation-of-pediatric-head-trauma
#17
Simone Langness, Erin Ward, Jonathan Halbach, Radhames Lizardo, Katherine Davenport, Stephen Bickler, Karen Kling, Hari Thangarajah, Julia Grabowski, Timothy Fairbanks
PURPOSE: Serum D-dimer has been proposed as a biomarker to aid in the diagnosis of pediatric traumatic brain injury (TBI). We investigated the accuracy of D-dimer in predicting the absence of TBI and evaluated the degree by which D-dimer could limit unnecessary computed tomography scans of the head (CTH). METHODS: Retrospective review of patients with suspected TBI from 2011 to 2013 who underwent evaluation with CTH and quantitative D-dimer. D-dimer levels were compared among patients with clinically-important TBI (ciTBI), TBI, isolated skull fracture and no injury...
April 2018: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/29554049/organ-donation-in-trauma-victims-a-systematic-review-and-meta-analysis
#18
Adam Cameron, Mete Erdogan, Sara Lanteigne, Alexandra Hetherington, Robert S Green
BACKGROUND: Although trauma patients represent a large pool of potential organ donors (PODs), the donor conversion rates (DCRs) in this population are unclear. Our primary objective was to synthesize published evidence on DCRs in trauma patients. As a secondary objective, we investigated factors that affect organ donation (OD) in the trauma population. METHODS: We searched four electronic databases (PubMed, Embase, Web of Science, Cochrane Library) and grey literature for articles on OD in trauma patients (PROSPERO 2017: CRD42017070388)...
March 16, 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29554046/the-evolution-of-pediatric-transfusion-practice-during-combat-operations-2001-2013
#19
Jeremy W Cannon, Lucas P Neff, Heather F Pidcoke, James K Aden, Philip C Spinella, Michael A Johnson, Andrew P Cap, Matthew A Borgman
BACKGROUND: Hemostatic resuscitation principles have significantly changed adult trauma resuscitation over the past decade. Practice patterns in pediatric resuscitation likely have changed as well; however, this evolution has not been quantified. We evaluated pediatric resuscitation practices over time within a combat trauma system. METHODS: The Department of Defense Trauma Registry (DoDTR) was queried from 2001-2013 for pediatric patients (<18 years). Patients with burns, drowning, and missing injury severity score (ISS) were excluded...
March 16, 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29554039/direct-to-operating-room-trauma-resuscitation-decreases-mortality-among-severely-injured-children
#20
Minna M Wieck, Aaron J Cunningham, Brandon Behrens, Erika T Ohm, Bryan G Maxwell, Nicholas A Hamilton, M Christopher Adams, Frederick J Cole, Mubeen A Jafri
BACKGROUND: Expediting evaluation and intervention for severely injured patients has remained a mainstay of advanced trauma care. One technique, direct to operating room (DOR) resuscitation, for selective adult patients has demonstrated decreased mortality. We sought to investigate the application of this protocol in children. METHODS: All DOR pediatric patients from 2009-2016 at a pediatric Level I Trauma Center were identified. DOR criteria included penetrating injury, chest injuries, amputations, significant blood loss, cardiopulmonary resuscitation, and surgeon discretion...
March 16, 2018: Journal of Trauma and Acute Care Surgery
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