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Popescu CM, Marina V, Popescu F, Oprea A. Electric Scooter Falls: The 2023-2024 Experience in the Clinical Emergency Children's Hospital in Galați. Clin Pract 2024; 14:1818-1826. [PMID: 39311295 PMCID: PMC11417887 DOI: 10.3390/clinpract14050145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Revised: 08/20/2024] [Accepted: 09/02/2024] [Indexed: 09/26/2024] Open
Abstract
(1) Introduction: Since electric scooters were launched in 2017, they have become increasingly popular worldwide and a cause of childhood trauma. (2) Case reports: This paper has a double-fold purpose: it reports two cases of epidural hematomas and compares them with electric scooter-related head trauma in the literature. An overview of the literature on this topic was performed to make such a comparison. Our cases are one of almost 52 cm3 and one of 129 cm3, both in two eight-year-olds. (3) Discussion: Although usually mild, traumatic brain injuries following e-scooter falls can also be moderate and severe. Reduced helmet use, high speed, and a lack of experience are the perfect set-up for potential severe injuries. Intracranial bleeds are not frequent, and epidural hematomas are rare in such cases, but they can significantly impact the individual, community, and healthcare system. No other medium- or large-sized epidural hematomas were reported in children sustaining electric scooter-related head trauma. (4) Conclusions: Our review parallels the literature and our hospital's experience. Although there are both similarities and discrepancies between our cases and the literature, mild trauma should not be disregarded, for it may hide serious complications requiring immediate surgery.
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Affiliation(s)
- Cristina-Mihaela Popescu
- Dental-Medicine Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University of Galati, 800201 Galati, Romania;
| | - Virginia Marina
- Medical Department of Occupational Health, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University of Galati, 47 Str. Domnească, 800201 Galati, Romania
| | - Floriana Popescu
- Department of English, Faculty of Letters, “Dunărea de Jos” University of Galati, 800201 Galati, Romania;
| | - Andreea Oprea
- Doctoral School, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University of Galati, 800201 Galati, Romania;
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Palavani LB, Bertani R, de Barros Oliveira L, Batista S, Verly G, Andreão FF, Ferreira MY, Paiva WS. A Systematic Review and Meta-Analysis on the Management and Outcome of Isolated Skull Fractures in Pediatric Patients. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1913. [PMID: 38136115 PMCID: PMC10741641 DOI: 10.3390/children10121913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/02/2023] [Accepted: 11/20/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND The impact of traumatic brain injury (TBI) on the pediatric population is profound. The aim of this study is to unveil the state of the evidence concerning acute neurosurgical intervention, hospitalizations after injury, and neuroimaging in isolated skull fractures (ISF). MATERIALS AND METHODS This systematic review was conducted in accordance with PRISMA guidelines. PubMed, Cochrane, Web of Science, and Embase were searched for papers until April 2023. Only ISF cases diagnosed via computed tomography were considered. RESULTS A total of 10,350 skull fractures from 25 studies were included, of which 7228 were ISF. For the need of acute neurosurgical intervention, the meta-analysis showed a risk of 0% (95% CI: 0-0%). For hospitalization after injury the calculated risk was 78% (95% CI: 66-89%). Finally, for the requirement of repeated neuroimaging the analysis revealed a rate of 7% (95% CI: 0-15%). No deaths were reported in any of the 25 studies. CONCLUSIONS Out of 7228 children with ISF, an almost negligible number required immediate neurosurgical interventions, yet a significant 74% were hospitalized for up to 72 h. Notably, the mortality was zero, and repeat neuroimaging was uncommon. This research is crucial in shedding light on the outcomes and implications of pediatric TBIs concerning ISFs.
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Affiliation(s)
- Lucca B. Palavani
- Faculty of Medicine, Max Planck University Center, Indaiatuba 13343-060, Brazil;
| | - Raphael Bertani
- Faculty of Medicine, São Paulo University, São Paulo 05508-220, Brazil
| | | | - Sávio Batista
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro 21941-617, Brazil; (S.B.); (G.V.)
| | - Gabriel Verly
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro 21941-617, Brazil; (S.B.); (G.V.)
| | - Filipi Fim Andreão
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro 21941-617, Brazil; (S.B.); (G.V.)
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Waseem M, Esposito KD, Cedano K, Shariff MA, Priovolos S. The Observation of Pediatric Skull Fractures Without an Associated Brain Injury in a Non-Trauma Center. Cureus 2023; 15:e50571. [PMID: 38222135 PMCID: PMC10788048 DOI: 10.7759/cureus.50571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 12/14/2023] [Indexed: 01/16/2024] Open
Abstract
Introduction Young children experiencing head trauma are prone to skull fractures. Pediatric skull fractures are distinct from adults as they have a greater capacity to undergo remodeling. The objective of this study was to evaluate whether children with isolated skull fractures without an underlying brain injury and normal neurological exam require a transfer to a tertiary hospital with pediatric neurosurgery service. Methods A retrospective chart review was performed to review children under five years old presenting to the emergency department of a non-pediatric trauma center with an isolated skull fracture resulting from head trauma without intracerebral hemorrhage between 2015 and 2021. The inclusion criteria consisted of children who have isolated skull fractures without underlying injuries and normal neurological examination. We reviewed these patients' injury characteristics, disposition, and clinical outcomes. The t-test and chi-square were used for evaluating the groups and evaluating the transfer to a dedicated trauma care facility. Results We identified 26 children who had isolated skull fractures with no underlying brain injury and normal neurological examination. The two most common mechanisms of injury were falls (64%) and motor vehicle collisions (MVC) (11%). The median age of patients was six months old. The location of the skull fractures was as follows: parietal (46%), occipital (19%), temporal (15%), frontal (7.7%), occipital + parietal (7.7%), and parietal + frontal (3.8%). Four fractures were depressed (15%) and the remainder were non-displaced. Eleven children with skull fractures (42%) were transferred to a designated pediatric trauma center and the remaining 58% were hospitalized for observation and monitored at the primary hospital. None of the children with skull fractures required intubation or other advanced interventions. Conclusion In this relatively limited sample, approximately one-third of the children with isolated skull fractures without brain injury were managed successfully in a non-tertiary care center. However, none of them required surgical intervention. Thus, we propose that patients akin to those in this study can be observed at a local hospital without being transferred to a pediatric trauma center.
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Affiliation(s)
- Muhammad Waseem
- Emergency Medicine, New York City (NYC) Health + Hospitals/Lincoln, New York, USA
| | | | - Katherine Cedano
- Pediatrics, New York City (NYC) Health + Hospitals/Lincoln, New York, USA
| | - Masood A Shariff
- Internal Medicine, New York City (NYC) Health + Hospitals/Lincoln, New York, USA
| | - Soula Priovolos
- Surgery, New York City (NYC) Health + Hospitals/Lincoln, New York, USA
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Greenberg JK, Ahluwalia R, Hill M, Johnson G, Hale AT, Belal A, Baygani S, Olsen MA, Foraker RE, Carpenter CR, Yan Y, Ackerman L, Noje C, Jackson E, Burns E, Sayama CM, Selden NR, Vachhrajani S, Shannon CN, Kuppermann N, Limbrick DD. Development and external validation of the KIIDS-TBI tool for managing children with mild traumatic brain injury and intracranial injuries. Acad Emerg Med 2021; 28:1409-1420. [PMID: 34245632 DOI: 10.1111/acem.14333] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/06/2021] [Accepted: 06/24/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Clinical decision support (CDS) may improve the postneuroimaging management of children with mild traumatic brain injuries (mTBI) and intracranial injuries. While the CHIIDA score has been proposed for this purpose, a more sensitive risk model may have broader use. Consequently, this study's objectives were to: (1) develop a new risk model with improved sensitivity compared to the CHIIDA model and (2) externally validate the new model and CHIIDA model in a multicenter data set. METHODS We analyzed children ≤18 years old with mTBI and intracranial injuries included in the PECARN head injury data set (2004-2006). We used binary recursive partitioning to predict the composite outcome of neurosurgical intervention, intubation for > 24 h due to TBI, or death due to TBI. The new model was externally validated in a separate data set that included children treated at any one of six centers from 2006 to 2019. RESULTS Based on 839 patients from the PECARN data set, a new risk model, the KIIDS-TBI model, was developed that incorporated imaging (e.g., midline shift) and clinical (e.g., Glasgow Coma Scale score) findings. Based on the model-predicted probability of the composite outcome, three cutoffs were evaluated to classify patients as "high risk" for level of care decisions. In the external validation data set consisting of 1,630 patients, the most conservative cutoff (i.e., any predictor present) identified 119 of 119 children with the composite outcome (sensitivity = 100%), but had the lowest specificity (26.3%). The other two decision-making cutoffs had worse sensitivity (94.1%-96.6%) but improved specificity (67.4%-81.3%). The CHIIDA model lacked the most conservative cutoff and otherwise showed the same or slightly worse performance compared to the other two cutoffs. CONCLUSIONS The KIIDS-TBI model has high sensitivity and moderate specificity for risk stratifying children with mTBI and intracranial injuries. Use of this CDS tool may help improve the safe, resource-efficient management of this important patient population.
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Affiliation(s)
- Jacob K. Greenberg
- Department of Neurological Surgery Washington University School of Medicine in St. Louis St. Louis MO USA
| | - Ranbir Ahluwalia
- Department of Neurological Surgery Vanderbilt University Medical Center Nashville TN USA
| | - Madelyn Hill
- Department of Neurological Surgery Dayton Children’s Hospital Dayton OH USA
| | - Gabbie Johnson
- Department of Neurological Surgery Washington University School of Medicine in St. Louis St. Louis MO USA
| | - Andrew T. Hale
- Department of Neurological Surgery Vanderbilt University Medical Center Nashville TN USA
| | - Ahmed Belal
- Department of Neurological Surgery Indiana University School of Medicine Indianapolis IN USA
| | - Shawyon Baygani
- Department of Neurological Surgery Indiana University School of Medicine Indianapolis IN USA
| | - Margaret A. Olsen
- Department of Medicine Washington University School of Medicine in St. Louis St. Louis MO USA
| | - Randi E. Foraker
- Department of Medicine Washington University School of Medicine in St. Louis St. Louis MO USA
| | - Christopher R. Carpenter
- Department of Emergency Medicine Washington University School of Medicine in St. Louis St. Louis MO USA
| | - Yan Yan
- Department of Surgery Washington University School of Medicine in St. Louis St. Louis MO USA
| | - Laurie Ackerman
- Department of Neurological Surgery Indiana University School of Medicine Indianapolis IN USA
| | - Corina Noje
- Department of Anesthesiology Johns Hopkins School of Medicine Baltimore MD USA
| | - Eric Jackson
- Department of Neurological Surgery Johns Hopkins School of Medicine Baltimore MD USA
| | - Erin Burns
- Department of Pediatrics Oregon Health and Science University Portland OR USA
| | - Christina M. Sayama
- Department of Neurological Surgery Oregon Health and Science University Portland OR USA
| | - Nathan R. Selden
- Department of Neurological Surgery Oregon Health and Science University Portland OR USA
| | | | - Chevis N. Shannon
- Department of Neurological Surgery Vanderbilt University Medical Center Nashville TN USA
- American Society for Reproductive Medicine University of California Davis Davis CA USA
| | - Nathan Kuppermann
- Department of Emergency Medicine University of California–Davis Davis CA USA
| | - David D. Limbrick
- Department of Neurological Surgery Washington University School of Medicine in St. Louis St. Louis MO USA
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Keane OA, Escobar MA, Neff LP, Mitchell IC, Chern JJ, Santore MT. Pediatric Mild Traumatic Brain Injury: Who Can Be Managed at a Non-pediatric Trauma Center Hospital? A Systematic Review of the Literature. Am Surg 2021; 88:447-454. [PMID: 34734550 DOI: 10.1177/00031348211050804] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pediatric traumatic brain injury (TBI) affects about 475,000 children in the United States annually. Studies from the 1990s showed worse mortality in pediatric TBI patients not transferred to a pediatric trauma center (PTC), but did not examine mild pediatric TBI. Evidence-based guidelines used to identify children with clinically insignificant TBI who do not require head CT were developed by the Pediatric Emergency Care Applied Research Network (PECARN). However, which patients can be safely observed at a non-PTC is not directly addressed. METHODS A systematic review of the literature was conducted, focusing on management of pediatric TBI and transfer decisions from 1990 to 2020. RESULTS Pediatric TBI patients make up a great majority of preventable transfers and admissions, and comprise a significant portion of avoidable costs to the health care system. Majority of mild TBI patients admitted to a PTC following transfer do not require ICU care, surgical intervention, or additional imaging. Studies have shown that as high as 83% of mild pediatric TBI patients are discharged within 24 hrs. CONCLUSIONS An evidence-based clinical practice algorithm was derived through synthesis of the data reviewed to guide transfer decision. The papers discussed in our systematic review largely concluded that transfer and admission was unnecessary and costly in pediatric patients with mild TBI who met the following criteria: blunt, no concern for NAT, low risk on PECARN assessment, or intermediate risk on PECARN with negative imaging or imaging with either isolated, nondisplaced skull fractures without ICH and/or EDH, or SDH <0.3 cm with no midline shift.
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Affiliation(s)
- Olivia A Keane
- Department of Surgery, 1371Emory University, Atlanta, GA, USA
| | - Mauricio A Escobar
- Department of Pediatric Surgery, 547254Mary Bridge Children's Hospital, Tacoma, WA, USA
| | - Lucas P Neff
- 12279Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Ian C Mitchell
- Departments of Surgery, 14742University of Texas Health Science Center at San Antonio and Baylor College of Medicine, San Antonio, TX, USA
| | - Joshua J Chern
- Department of Neurosurgery, 1371Emory University School of Medicine, Atlanta, GA USA
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Greenberg JK, Otun A, Nasraddin A, Brownson RC, Kuppermann N, Limbrick DD, Yen PY, Foraker RE. Electronic clinical decision support for children with minor head trauma and intracranial injuries: a sociotechnical analysis. BMC Med Inform Decis Mak 2021; 21:161. [PMID: 34011315 PMCID: PMC8132484 DOI: 10.1186/s12911-021-01522-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 05/09/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Current management of children with minor head trauma (MHT) and intracranial injuries is not evidence-based and may place some children at risk of harm. Evidence-based electronic clinical decision support (CDS) for management of these children may improve patient safety and decrease resource use. To guide these efforts, we evaluated the sociotechnical environment impacting the implementation of electronic CDS, including workflow and communication, institutional culture, and hardware and software infrastructure, among other factors. METHODS Between March and May, 2020 semi-structured qualitative focus group interviews were conducted to identify sociotechnical influences on CDS implementation. Physicians from neurosurgery, emergency medicine, critical care, and pediatric general surgery were included, along with information technology specialists. Participants were recruited from nine health centers in the United States. Focus group transcripts were coded and analyzed using thematic analysis. The final themes were then cross-referenced with previously defined sociotechnical dimensions. RESULTS We included 28 physicians and four information technology specialists in seven focus groups (median five participants per group). Five physicians were trainees and 10 had administrative leadership positions. Through inductive thematic analysis, we identified five primary themes: (1) clinical impact; (2) stakeholders and users; (3) tool content; (4) clinical practice integration; and (5) post-implementation evaluation measures. Participants generally supported using CDS to determine an appropriate level-of-care for these children. However, some had mixed feelings regarding how the tool could best be used by different specialties (e.g. use by neurosurgeons versus non-neurosurgeons). Feedback from the interviews helped refine the tool content and also highlighted potential technical and workflow barriers to address prior to implementation. CONCLUSIONS We identified key factors impacting the implementation of electronic CDS for children with MHT and intracranial injuries. These results have informed our implementation strategy and may also serve as a template for future efforts to implement health information technology in a multidisciplinary, emergency setting.
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Affiliation(s)
- Jacob K Greenberg
- Departments of Neurological Surgery, Washington University School of Medicine, 660 S. Euclid Ave., Box 8057, St. Louis, MO, 63110, USA.
| | - Ayodamola Otun
- Departments of Neurological Surgery, Washington University School of Medicine, 660 S. Euclid Ave., Box 8057, St. Louis, MO, 63110, USA
| | - Azzah Nasraddin
- Brown School of Social Work, Washington University School of Medicine, St. Louis, MO, USA
| | - Ross C Brownson
- Brown School of Social Work, Washington University School of Medicine, St. Louis, MO, USA
| | - Nathan Kuppermann
- Department of Emergency Medicine, University of California Davis, Davis, CA, USA
| | - David D Limbrick
- Departments of Neurological Surgery, Washington University School of Medicine, 660 S. Euclid Ave., Box 8057, St. Louis, MO, 63110, USA
| | - Po-Yin Yen
- Institute for Informatics, Washington University School of Medicine, St. Louis, MO, USA
| | - Randi E Foraker
- Institute for Informatics, Washington University School of Medicine, St. Louis, MO, USA
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Kim JS, Kim JC, Sung WY. Identification of practically important traumatic brain injury using Pediatric Emergency Care Applied Research Network rule in children younger than 2 years with minor head trauma. HONG KONG J EMERG ME 2020. [DOI: 10.1177/1024907920975371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Minor head trauma is frequently presented to the pediatric emergency department. Despite the burden this injury poses on public health, evidence-based clinical guidelines on the assessment and management of pediatric minor head trauma remain unestablished, particularly in children below 2 years. We aimed to assess the diagnostic accuracy of a clinical decision rule (Pediatric Emergency Care Applied Research Network rule) and physician discretion in the recognition of practically important traumatic brain injury in children below 2 years of age presenting with minor head trauma to the emergency department. Methods: The medical records of children younger than 2 years presenting with head trauma to the emergency department were reviewed with Glasgow Coma Scale scores of 14–15. Practically important traumatic brain injury is a clinically essential traumatic brain injury including all cranial abnormalities (e.g. skull fracture) detected by computed tomography. All predictor variables of the Pediatric Emergency Care Applied Research Network rule and practically important traumatic brain injury outcomes were validated. Results: We enrolled and analyzed 433 children below 2 years. The most frequently observed mechanisms of injury in decreasing order were as follows: falls > 90 cm, head struck by high-impact objects, slip down, and automobile traffic accident. Of 224 children, positive findings were observed in 35 and 144 had one or more predictors of Pediatric Emergency Care Applied Research Network rule. The sensitivity, specificity, and negative likelihood ratio of the Pediatric Emergency Care Applied Research Network rule for practically important traumatic brain injury were 94.3%, 41.3%, and 0.14, respectively. Conclusion: The Pediatric Emergency Care Applied Research Network rule would assist in clinical decision-making to appropriately detect potential head injuries in children below 2 years, thereby reducing unnecessary performance of computed tomography scan.
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Affiliation(s)
- Jon Soo Kim
- Department of Pediatrics, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Jin Cheol Kim
- Department of Emergency Medicine, Eulji University Hospital, Daejeon, Republic of Korea
| | - Won Young Sung
- Department of Emergency Medicine, Eulji University Hospital, Daejeon, Republic of Korea
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Call L, Qiu Q, Morris J, Flaherty B, Vavilala MS, Mills B, Bratton S, Mossa-Basha M. Characteristics of pediatric patients with traumatic epidural hematomas who can be safely observed: a clinical validation study. Br J Radiol 2020; 93:20190968. [PMID: 32762545 DOI: 10.1259/bjr.20190968] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE The study aimed to validate admission clinical and radiographic features of pediatric patients with traumatic epidural hematoma (EDH) that lead to safe observation. METHODS A Level I trauma center radiology and electronic medical record databases were retrospectively queried for pediatric patients with EDH on CT scan between 1/1/2016 and 10/1/2016. Patient imaging, treatment and outcome variables were abstracted. Characteristics of the cohort were compared to an external cohort used to develop prediction rules for surgical intervention. External validity of the prediction rules was assessed. RESULTS 195 eligible subjects were included in the study, 37 of which failed observation and required surgery while 158 underwent successful observation. The surgical cohort had significantly thicker (p < .001) and higher volume (p < .001) EDH, increased midline shift (p < .001) and higher likelihood of mass effect (p < .001). There was significantly higher residual neurologic deficit rate (54% vs 23%, p < .001) and hospital mortality (5% vs 0%, p = .035) amongst the surgical group. There were significant differences in patient demographic, clinical and imaging characteristics between the internal and external cohorts. The predictive rules externally developed yielded positive predictive value of 97.7% (95% CI = 93.3-99.5%), negative predictive value of 24.5% (95% CI = 16.2-34.4%), specificity of 88.5% (95% CI = 69.9-97.6%), and sensitivity of 63.8% (95% CI = 56.6-70.5%) for successful observation. CONCLUSION The current study validates previously developed prediction rules for safe observation of pediatric EDH in a cohort with distinct characteristics from the external cohort. Specifically, patients with no mass effect, EDH volume <15 ml and no neurological deficits are less likely to fail observation. ADVANCES IN KNOWLEDGE The current study validates prediction rules for safe observation of pediatric EDH in a distinct pediatric cohort that provides further support to conservative management in these circumstances.
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Affiliation(s)
- Lindsay Call
- Amherst College, 220 South Pleasant Street, Amherst, MA 01002
| | - Qian Qiu
- Harborview Injury Prevention Research Center, 401 Broadway St, Seattle, WA 98104, United States
| | - Jeffrey Morris
- Department of Radiology, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, United States
| | - Brian Flaherty
- Department of Pediatrics, University of Utah, 100 N Mario Capecchi Drive, Salt Lake City, UT 84113, United States
| | - Monica S Vavilala
- Department of Anesthesia, Harborview Medical Center, 325 9th Ave, Seattle, WA 98104, United States
| | - Brianna Mills
- Harborview Injury Prevention Research Center, 401 Broadway St, Seattle, WA 98104, United States
| | - Susan Bratton
- Department of Pediatrics, University of Utah, 100 N Mario Capecchi Drive, Salt Lake City, UT 84113, United States
| | - Mahmud Mossa-Basha
- Department of Radiology, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, United States
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Stephens S, Ma N. Ceiling Fan-Related Head Injuries in Children: A Queensland Neurosurgical Experience. Pediatr Neurosurg 2020; 55:74-80. [PMID: 32428916 DOI: 10.1159/000507452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 03/20/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Ceiling fans are a widespread energy-efficient appliance required for managing the sweltering weather extremes encountered in northern Australian states including Queensland. Ceiling fans are also a rare cause of serious head injury in children requiring neurosurgical intervention. There is limited available evidence on the presentation, mechanism, and management of these injuries. METHODS A retrospective analysis of children who suffered ceiling fan injuries admitted to the Queensland Children's Hospital, a level-1 paediatric trauma hospital in Brisbane, Queensland, under the neurosurgery unit from November 2014 to July 2018 was performed. RESULTS Seventeen children (64.7% male) with a mean age of 4.24 years (range 0.66-7.25) sustained ceiling fan injuries requiring neurosurgical management during this period. Children were injured following being accidentally lifted or thrown into the ceiling fan path; jumping, playing, climbing, or being pushed from a bunk bed; or climbing on other furniture. All patients suffered skull fractures (88.2% depressed), and 65% suffered extra-axial or intracerebral haemorrhage. Operative management was required in 76.5% of the patients. No patients suffered adverse outcomes, and no complications, including infections, were recorded. CONCLUSIONS Despite their rarity, paediatric ceiling fan injuries requiring neurosurgical management are a cause of significant morbidity. Surgical management targeted elevation of depressed fractures and washout of open fractures rather than evacuation of intracranial collections. Almost all included patients required transfer with associated social and economic implications. Such injuries are largely preventable with improved supervision and safety awareness. Hazard modification may be extended to regulatory changes or improved ceiling fan design.
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Affiliation(s)
- Sean Stephens
- Neurosurgical Department, Queensland Children's Hospital, Brisbane, Queensland, Australia,
| | - Norman Ma
- Neurosurgical Department, Queensland Children's Hospital, Brisbane, Queensland, Australia
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Stephens S, Campbell R, Chaseling R, Ma N. Traumatic brain injuries in a paediatric neurosurgical unit: A Queensland experience. J Clin Neurosci 2019; 70:27-32. [DOI: 10.1016/j.jocn.2019.09.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 07/21/2019] [Accepted: 09/04/2019] [Indexed: 12/17/2022]
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