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Head trauma in pediatric patients

Felipe P Andrade, Roberto Montoro, Renan Oliveira, Gabriela Loures, Luana Flessak, Roberta Gross, Camille Donnabella, Andrea Puchnick, Lisa Suzuki, Rodrigo Regacini
OBJECTIVES: 1) To verify clinical signs correlated with appropriate cranial computed tomography scan indications and changes in the therapeutic approach in pediatric minor head trauma scenarios. 2) To estimate the radiation exposure of computed tomography scans with low dose protocols in the context of trauma and the additional associated risk. METHODS: Investigators reviewed the medical records of all children with minor head trauma, which was defined as a Glasgow coma scale ≥13 at the time of admission to the emergency room, who underwent computed tomography scans during the years of 2013 and 2014...
October 1, 2016: Clinics
Wayne Stark, Annie Rominger, Fred Warkentine, Kerry Caperell
OBJECTIVE: This study aimed to evaluate the diagnostic utility of empiric head computed tomography (CT) in apparent life threatening event (ALTE). METHODS: This was a retrospective chart review of children younger than 12 months presenting to an urban pediatric hospital and its suburban satellite for an ALTE from October 2009 to December 2012. The ALTE cases were identified as having had a diagnosis of ALTE (International Classification of Diseases, 9th Revision 799...
October 6, 2016: Pediatric Emergency Care
Ashley Blanchard, Keven I Cabrera, Nathan Kuppermann, Peter S Dayan
OBJECTIVES: We aimed to determine the prevalence of and adverse outcomes caused by pneumocephali in children with minor blunt head trauma who had no other intracranial injuries (ie, isolated pneumocephali). METHODS: We conducted a secondary analysis of a public use dataset from a multicenter prospective study of pediatric minor head trauma. We included children younger than 18 years with Glasgow Coma Scale (GCS) scores of 14 or 15 and non-trivial mechanisms of injury who had cranial computed tomographies obtained...
October 6, 2016: Pediatric Emergency Care
Nathan Vaughan, Jeff Tweed, Cynthia Greenwell, David M Notrica, Crystal S Langlais, Shawn D St Peter, Charles M Leys, Daniel J Ostlie, R Todd Maxson, Todd Ponsky, David W Tuggle, James W Eubanks, Amina Bhatia, Cynthia Greenwell, Nilda M Garcia, Karla A Lawson, Prasenjeet Motghare, Robert W Letton, Adam C Alder
INTRODUCTION: Obesity is an epidemic in the pediatric population. Childhood obesity in trauma has been associated with increased incidence of long-bone fractures, longer ICU stays, and decreased closed head injuries. We investigated for differences in the likelihood of failure of non-operative management (NOM), and injury grade using a subset of a multi-institutional, prospective database of pediatric patients with solid organ injury (SOI). METHODS: We prospectively collected data on all pediatric patients (<18years) admitted for liver or splenic injury from September 2013 to January 2016...
September 13, 2016: Journal of Pediatric Surgery
Madison M Hunt, Austin M Stevens, Kristine W Hansen, Stephen J Fenton
PURPOSE: To expedite flow of injured children suspected to require operative intervention, a "trauma 1 OP" (T1OP) activation classification was created. The purpose of this study was to review this strategy at a level 1 pediatric trauma center. METHODS: A retrospective review of T1OP activations between 2003 and 2015 was performed. Children suspected of requiring neurosurgical intervention were classified as trauma 1 OP neuro (T1OP(N)). Comparisons were made to trauma 1 (T1) patients who required emergent operative intervention, excluding orthopedic injuries...
September 14, 2016: Journal of Pediatric Surgery
Erich M Gauger, Lauren L Casnovsky, Erica J Gauger, Deborah C Bohn, Ann E Van Heest
This study reviewed the clinical history and management of acquired growth arrest in the upper extremity in pediatric patients. The records of all patients presenting from 1996 to 2012 with radiographically proven acquired growth arrest were reviewed. Records were examined to determine the etiology and site of growth arrest, management, and complications. Patients with tumors or hereditary etiology were excluded. A total of 44 patients (24 boys and 20 girls) with 51 physeal arrests who presented at a mean age of 10...
September 29, 2016: Orthopedics
Kelly A Feldman, Jun Tashiro, Casey J Allen, Eduardo A Perez, Holly L Neville, Carl I Schulman, Juan E Sola
BACKGROUND: Although firearms account for less than 5 % of all pediatric injuries, they have the highest associated case fatality rate. METHODS: The registry at a Level-1 trauma center was used to identify firearm injuries (<18 years of age) from 1991 to 2011. Descriptive statistics and risk-adjusted multivariate analyses (MVA) were performed. RESULTS: Overall, 1085 patients were identified. Immediate operations were performed in 33 % (n = 358) of patients with most having abdominal surgery (n = 214)...
September 28, 2016: Pediatric Surgery International
Alexander Leung, Patrick Bonasso, Kevin Lynch, Dustin Long, Richard Vaughan, Alison Wilson, Jorge Con
Secondary overtriage is a term that describes patients who are discharged home shortly after being transferred, an indication that transfer and hospitalization were unnecessary. The study goal was to identify factors associated with secondary triage. A statewide trauma registry was used to identify trauma patients aged less than 18 years during a 6-year period (2007-2012) who were discharged within 48 hours from arrival and did not undergo a surgical procedure. We compared those that were treated at initial facility and those transferred to a second facility using clinical indices including patterns of injury pattern using multivariate logistic regression...
September 2016: American Surgeon
Rachel M Stanley, Michael D Johnson, Cheryl Vance, Lalit Bajaj, Lynn Babcock, Shireen Atabaki, Danny Thomas, Harold K Simon, Daniel M Cohen, Daniel Rubacalva, P David Adelson, Blake Bulloch, Alexander J Rogers, Prashant Mahajan, Jill Baren, Lois Lee, John Hoyle, Kimberly Quayle, T Charles Casper, J Michael Dean, Nathan Kuppermann
OBJECTIVES: In preparation for a clinical trial of therapeutic agents for children with moderate-to-severe blunt traumatic brain injuries (TBIs) in emergency departments (EDs), we conducted this feasibility study to 1) determine the number and clinical characteristics of eligible children, 2) determine the timing of patient and guardian arrival to the ED, and 3) describe the heterogeneity of TBIs on computed tomography (CT) scans. METHODS: We conducted a prospective observational study at 16 EDs of children ≤ 18 years of age presenting with blunt head trauma and Glasgow Coma Scale (GCS) scores of 3-12...
September 12, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Kazuya Matsuo, Nobuyuki Akutsu, Kunitoshi Otsuka, Kazuki Yamamoto, Atsufumi Kawamura, Tatsuya Nagashima
PURPOSE: Various treatment modalities have been used in the management of chronic subdural hematoma and subdural hygroma (CSDH/SDHy) in children. However, few studies have examined burr-hole craniotomy without continuous drainage in such cases. Here, we retrospectively evaluated the efficacy and safety of burr-hole craniotomy without continuous drainage for CSDH/SDHy in children under 2 years old. We also aimed to determine the predictors of CSDH/SDHy recurrence. METHODS: We conducted a retrospective chart review of 25 children under 2 years old who underwent burr-hole craniotomy without continuous drainage for CSDH/SDHy at a pediatric teaching hospital over a 10-year period...
September 9, 2016: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
Sohum K Desai, Da'Marcus Baymon, Eric Sieloff, Kenneth Maynard, Marc Moisi, Achal P Patel, Joel T Patterson
AIMS: Lateral transtemporal approaches are useful for addressing lesions located ventral to the brainstem, especially when the pathologic diagnosis of the tumor dictates that a gross or near total resection improves outcomes. One approach, the presigmoid approach receives little attention in the pediatric population thus far. We sought to characterize morphometric changes, particularly the clival depth and the petroclival Cobb angle, that occur in the temporal bones of children and draw implications about doing a presigmoid approach in children...
April 2016: Journal of Pediatric Neurosciences
Ahmet Küçük, Abdulfettah Tümtürk
AIM: Television tip overs and head traumas in children showed an increase in the recent years in Turkey and throughout the World. In this study, the injury types, the surgical interventions and the children exposed to head trauma due to an accident caused by a falling television were investigated retrospectively. Some cautions were suggested in order to prevent these injuries. MATERIAL AND METHODS: In the study, the gender, age, Pediatric Glasgow Coma Scale, radiologic findings, the need for intensive care unit, the period spent in the hospital, the applied surgical treatments, the accompanied treatment and pathology of 36 children's case treated in the neurosurgery department of the Erciyes University School of Medicine were evaluated...
April 26, 2016: Turkish Neurosurgery
Rajib Lodh, Poppy Siddell, Jonathan Jones, Matthew C H J Morrall
INTRODUCTION: The majority of severely injured children in England have a significant head injury and will be seen in Major Trauma Centers (MTCs). The period following brain injury represents an opportunity to influence recovery of neurological function. The study sought to determine whether children who had sustained a head injury were referred for neurorehabilitation. METHOD: The study was conducted over one year at one center. Children sustaining a moderate or severe head injury were identified and compared to those referred for neurorehabilitation...
September 2, 2016: Developmental Neurorehabilitation
Samantha L Schoell, Ashley A Weaver, Jennifer W Talton, Gretchen Baker, Andrea N Doud, Ryan T Barnard, Joel D Stitzel, Mark R Zonfrillo
OBJECTIVE: The objective of the study was to develop a disability-based metric for motor vehicle crash (MVC) injuries, with a focus on head injuries, and compare the functional outcomes between the pediatric and adult populations. METHODS: Disability risk (DR) was quantified using Functional Independence Measure (FIM) scores within the National Trauma Data Bank-Research Data System (NTDB-RDS) for the top 95% most frequently occurring Abbreviated Injury Scale (AIS) 3, 4, and 5 head injuries in NASS-CDS 2000-2011...
September 2016: Traffic Injury Prevention
Rosemary Nabaweesi, Raghu H Ramakrishnaiah, Mallikarjuna R Rettiganti, Chunqiao Luo, Charles M Glasier, Robert T Maxson, Mary E Aitken, Philip J Kenney, James M Robbins
PURPOSE: The long-term cancer risks for children exposed to radiologic images can be two to three times higher than for adults because children are more sensitive to radiation and have a longer lifetime in which to accumulate exposure from CT scans. Injured children often undergo repeat CT imaging if they are transferred from non-pediatric hospitals to a Level I pediatric trauma center (PTC). This study determined the impact of a statewide web-based image repository (WBIR) on repeat imaging among transferred injured children...
August 28, 2016: Journal of the American College of Radiology: JACR
Brian R Englum, Brian C Gulack, Henry E Rice, John E Scarborough, Obinna O Adibe
PURPOSE: This study aims to examine the current management strategies and outcomes after blunt pancreatic trauma in children using a national patient registry. METHODS: Using the National Trauma Data Bank (NTDB) from 2007-2011, we identified all patients ≤18years old who suffered blunt pancreatic trauma. Patients were categorized as undergoing nonoperative pancreatic management (no abdominal operation, abdominal operation without pancreatic-specific procedure, or pancreatic drainage alone) or operative pancreatic management (pancreatic resection/repair)...
September 2016: Journal of Pediatric Surgery
P-A Beuriat, A Szathmari, B Grassiot, F Di Rocco, C Mottolese
INTRODUCTION: The use of an autologous bone graft to repair a cranial bone defect is sometimes impossible in pediatric cases. CUSTOMBONE(®) made with hydroxyapatite is a good alternative in these indications for neurosurgeons. MATERIAL AND METHODS: We present a pediatric series of 19 children who benefited from a cranioplasty using CUSTOMBONE(®). Their ages ranged between 8 months and 13 years with a mean of 6 years and 2 months. The most frequent indication was a cranioplasty after a post-traumatic decompressive craniectomy...
August 17, 2016: Neuro-Chirurgie
Brandon Scott, Brandon Taylor, Joseph R Shung, Prasit Nimityongskul
: Femoral neck and pelvic fractures are rarely encountered in the pediatric population secondary to the resilient nature of the immature skeleton. Both fracture types usually result from high-energy blunt trauma including motor vehicle collisions, motor vehicle-pedestrian accidents, and falls from height. Considerable studies have been published on the natural history, management, and complications of pediatric pelvis and femoral neck fractures. However, few case reports have documented both fracture types in the same patient...
August 4, 2016: Journal of Pediatric Orthopedics. Part B
Satish Nair, Ajith Nilakantan, Amit Sood, Atul Gupta, Abhishek Gupta
Laryngeal stenosis is one of the most complex and challenging problems in the field of head and neck surgery. The management involves a multidisciplinary approach with multiple complex procedures. In this study we discuss our experience of laryngeal stenosis with regards to patient characteristics, cause and management. A retrospective analysis of 35 patients of laryngeal stenosis treated at a tertiary care centre was evaluated. Inclusion criteria were all patients with laryngeal stenosis who required surgical intervention...
September 2016: Indian Journal of Otolaryngology and Head and Neck Surgery
Stephen S Ttendo, Adam Was, Mark A Preston, Emmanuel Munyarugero, Vanessa B Kerry, Paul G Firth
BACKGROUND: We describe delivery and outcomes of critical care at Mbarara Regional Referral Hospital, a Ugandan secondary referral hospital serving a large, widely dispersed rural population. METHODS: Retrospective observational study of ICU admissions was performed from January 2008 to December 2011. RESULTS: Of 431 admissions, 239 (55.4 %) were female, and 142 (33.2 %) were children (<18 years). The median length of stay was 2 (IQR 1-4) days, with 365 patients (85 %) staying less than 8 days...
August 9, 2016: World Journal of Surgery
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