Pediatric Injuries: New Insights into Management, Prevention, and Education

A special issue of Children (ISSN 2227-9067). This special issue belongs to the section "Global and Public Health".

Deadline for manuscript submissions: closed (25 May 2023) | Viewed by 17460

Special Issue Editors

Department of Emergency and Disaster Medicine, Hirosaki University, Hirosaki, Japan
Interests: pediatric emergency medicine; medical & health profession education; sepsis; kawasaki disease; pediatric trauma care
Division of Pediatric Emergency Medicine, Tokyo Metropolitan Children’s Medical Center, Tokyo 183-8561, Japan
Interests: pediatric emergency medicine; pediatric trauma care; point-of-care ultrasound

Special Issue Information

Dear Colleagues,

Trauma is one of the most important causes of morbidity and mortality in the pediatric population. Accurate and timely diagnosis and treatment of trauma are paramount. In order to achieve this, a detailed medical history and physical examination, augmented by appropriate laboratory tests and diagnostic imaging, is necessary. Radiography, computed tomography, and magnetic resonance imaging are used to confirm the diagnosis; however, radiation exposure and the requirement for procedural sedation also make these techniques less than desirable.  Several prediction rules have been incorporated into pediatric emergency care, in order to avoid unnecessary diagnostic imaging. In addition, ultrasonography has recently began to play an important role in diagnosing pediatric trauma. Last, but not least, injury prevention and education for trainees are essential segments of pediatric emergency care. For instance, the implementation of the national action plan for child injury prevention in the US has decreased mortality in pediatric trauma patients.  The aim and scope of this Special Issue is to broaden the insight into pediatric trauma care. This Special Issue addresses a wide variety of topics that surround pediatric trauma, including pre-hospital care, diagnosis, treatment, prevention, and education . We hope that the research in this issue, which has developed novel innovations and scientific advances, will improve pediatric trauma care.

Dr. Osamu Nomura
Dr. Takaaki Mori
Guest Editors

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Keywords

  • pre-hospital care
  • pediatric emergency radiology
  • pediatric point of care ultrasound
  • prediction rule
  • physical examination in children
  • injury prevention
  • training for pediatric trauma care

Published Papers (10 papers)

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Research

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12 pages, 887 KiB  
Article
Teacher Preparedness for Medical Emergencies in Belgian Classrooms: Studying Objective and Subjective First-Aid Knowledge
by Maya Vermonden, Liesse Dehaerne, Jaan Toelen and David De Coninck
Children 2023, 10(4), 669; https://doi.org/10.3390/children10040669 - 31 Mar 2023
Cited by 1 | Viewed by 1543
Abstract
About one in seven accidents involving children occurs at school. Roughly 70% of these accidents involve children under the age of 12 years. Thus, primary school teachers may be confronted with accidents where first aid could improve the outcome. Despite the importance of [...] Read more.
About one in seven accidents involving children occurs at school. Roughly 70% of these accidents involve children under the age of 12 years. Thus, primary school teachers may be confronted with accidents where first aid could improve the outcome. Despite the importance of first-aid knowledge among teachers, little is known about this topic. To fill this gap, we conducted case-based survey research on the objective and subjective first-aid knowledge of primary school and kindergarten teachers in Flanders, Belgium. An online survey was distributed to primary school and kindergarten teachers. It included 14 hypothetical first-aid scenarios in a primary school context to assess objective knowledge, along with one item to assess subjective knowledge. A total of 361 primary school and kindergarten teachers completed the questionnaire. The participants achieved an average knowledge score of 66%. Those who had completed a first-aid course had significantly higher scores. Knowledge regarding child CPR was amongst the lowest, with only 40% correct answers. Structural equation modeling showed that only previous first-aid training, recent experience with first aid, and subjective first-aid knowledge were linked to teachers’ objective first-aid knowledge—particularly for basic first aid. This study shows that completing a first-aid course and completing a refresher course can predict objective first-aid knowledge. We therefore recommend that first-aid training and regular refresher courses should be mandatory in teacher training, given that a large share of teachers may need to apply first aid to a pupil at some point during their career. Full article
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8 pages, 792 KiB  
Article
Evaluating Emotional Outcomes of Medical Students in Pediatric Emergency Medicine Telesimulation
by Osamu Nomura, Momoka Sunohara, Ichiro Watanabe and Taichi Itoh
Children 2023, 10(1), 169; https://doi.org/10.3390/children10010169 - 15 Jan 2023
Cited by 2 | Viewed by 1494
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has challenged the feasibility of traditional in-person simulation-based clinical training due to the public health recommendation on social distancing. During the pandemic, telesimulation training was implemented to avoid multiple students and faculties gathering in confined spaces. While [...] Read more.
The coronavirus disease 2019 (COVID-19) pandemic has challenged the feasibility of traditional in-person simulation-based clinical training due to the public health recommendation on social distancing. During the pandemic, telesimulation training was implemented to avoid multiple students and faculties gathering in confined spaces. While medical trainees’ perceived emotions have been acknowledged as a critical outcome of the in-person simulation-based training, the impact of telesimulation on trainees’ emotions has been unexamined. We conducted an educational team-based simulation study with a pediatric case of septic shock. Seventeen and twenty-four medical students participated in the telesimulation training and in-person simulation training, respectively. The institutional pandemic social restrictions at the time of each training session determined the participant assignment to either the telesimulation training or in-person simulation training. All participants responded to the Japanese version of the Medical Emotion Scale, which includes 20 items rated on a five-point Likert-type scale before, during, and after the simulation sessions. The measured emotions were categized into four emotion groups according to two dimensions: positive or negative and activating or deactivating emotions. The one-way analysis of variance between the telesimulation and in-person simulation training revealed no significant differences in the emotions perceived by the participants before, during, and after the simulation training sessions. The perceived emotions of medical students were comparable between the telesimulation and in-person simulation training. Further longitudinal studies with larger samples and multiple variables are needed to generalize the effectiveness of telesimulation. Full article
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12 pages, 641 KiB  
Article
Adapting the Motivated Strategies for Learning Questionnaire to the Japanese Problem-Based Learning Context: A Validation Study
by Osamu Nomura, Yuki Soma, Hiroshi Kijima and Yasushi Matsuyama
Children 2023, 10(1), 154; https://doi.org/10.3390/children10010154 - 12 Jan 2023
Cited by 1 | Viewed by 1929
Abstract
The COVID-19 pandemic has greatly changed medical education, and medical trainees’ self-regulation has become more emphasized. In Japan, the concept of self-regulated learning has not been fully applied in health profession education due to a lack of effective measurement tools. We aimed to [...] Read more.
The COVID-19 pandemic has greatly changed medical education, and medical trainees’ self-regulation has become more emphasized. In Japan, the concept of self-regulated learning has not been fully applied in health profession education due to a lack of effective measurement tools. We aimed to validate the translated Japanese version of the Motivated Strategies for Learning Questionnaire in the context of Problem-Based Learning (J-MSLQ-PBL). The questionnaire employs a seven-point Likert-type scale with 81 items and is categorized into two sections: motivation and learning strategies. An exploratory factor analysis (EFA) was conducted by using Promax rotation to examine the factor structure of the scale, using the collected data from 112 Japanese medical students. Factor extraction was based on a scree plot investigation, and an item was accepted when the factor loading was ≥0.40. In the motivation section, the extracted factors from the EFA were well aligned with the subscales of the original MSLQ, including “Self-Efficacy for Learning and Performance”, “Task Value”, “Self-Efficacy for Learning and Performance”, “Test Anxiety”, “Extrinsic Goal Orientation”, and “Intrinsic Goal Orientation”. In the learning strategies, the extracted factors poorly matched the structure of the original subscales. This discrepancy could be explained by insufficient translation, the limited sample size from a single medical school, or cross-cultural differences in learning strategies between Western and Japanese medical students. Only the motivation part of the J-MSLQ-PBL should be implemented to measure the competency elements of self-regulated learning in Japan. Full article
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11 pages, 4460 KiB  
Article
Understanding Parental Perceptions of Content-Specific Barriers to Preventing Unintentional Injuries in the Home
by Mikiko Oono, Yoshifumi Nishida, Koji Kitamura and Tatsuhiro Yamanaka
Children 2023, 10(1), 41; https://doi.org/10.3390/children10010041 - 25 Dec 2022
Cited by 1 | Viewed by 1291
Abstract
Background: Preventable injuries are the leading cause of death in children around the world, including in Japan. As children under the age of 5 years spend most of their time at home, home injury prevention is critical for child safety. The purpose of [...] Read more.
Background: Preventable injuries are the leading cause of death in children around the world, including in Japan. As children under the age of 5 years spend most of their time at home, home injury prevention is critical for child safety. The purpose of this study was to identify specific, focused, and precise barriers against injury prevention practice. Methods: We conducted an online survey to examine the barriers faced by parents when taking actions to prevent home injuries. Results: The results revealed common reasons why parents do not or cannot take a recommended action across injury types, and that the magnitude of importance for a specific barrier depends on the type of injury. Conclusions: Identifying content-specific barriers could help researchers and educators understand parents’ needs, discuss what barriers are more important than others by injury type, and develop effective strategies based on the 3Es of injury prevention (enforcement, engineering, and education). Full article
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7 pages, 703 KiB  
Article
Blood Lost: A Retrospective Review of Blood Wastage from a Massive Transfusion Protocol in a Tertiary Paediatric Hospital
by Debbra Chong, Joyce Ching Mei Lam, Xun Yi Jasmine Feng, Mui Ling Heng, Yee Hui Mok, Li-Wei Chiang, Kee Chong Ng and Yong-Kwang Gene Ong
Children 2022, 9(12), 1799; https://doi.org/10.3390/children9121799 - 23 Nov 2022
Cited by 1 | Viewed by 1362
Abstract
Background: The paediatric massive transfusion protocol (MTP) is activated in the paediatric population for both trauma and non-trauma related indications. While it helps to improve the efficiency and efficacy of the delivery of blood products, it can also result in increased wastage. We [...] Read more.
Background: The paediatric massive transfusion protocol (MTP) is activated in the paediatric population for both trauma and non-trauma related indications. While it helps to improve the efficiency and efficacy of the delivery of blood products, it can also result in increased wastage. We aimed to evaluate the wastage rates from our paediatric MTP activations from 2013 to 2018. Method: As part of an audit, we retrospectively reviewed the records of the paediatric patients who had MTP activations. We collected the following data: reason for MTP activation, weight of patient, number of cycles of MTP required, blood products used, blood products wasted, deviation from our institution’s recommended MTP blood product ratio, and reason for wastage. Result: We had 26 paediatric MTP activations within the audit period. There was an overall wastage rate of 1.5%, with wastage occurring in 3 out of 26 patients. The reason for all wastage was demise of the patient. Most patients’ transfusion ratios deviated from our institution’s MTP protocol. Conclusion: Our wastage rates are low likely because of clear MTP activation guidelines and a flexible MTP workflow. Full article
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16 pages, 529 KiB  
Article
Factors Associated with an Increase in On-Site Time of Pediatric Trauma Patients in a Prehospital Setting: A Nationwide Observational Study in Japan
by Shunichi Otaka, Hiroyuki Ohbe, Ryuhei Igeta, Takuyo Chiba, Shunya Ikeda and Takashi Shiga
Children 2022, 9(11), 1658; https://doi.org/10.3390/children9111658 - 29 Oct 2022
Viewed by 1435
Abstract
The factors that prolong the on-site time in pediatric trauma cases in a prehospital setting are unknown. We investigated these factors using a national trauma registry in Japan. We identified pediatric trauma patients aged ≤18 years, from January 2004 to May 2019. We [...] Read more.
The factors that prolong the on-site time in pediatric trauma cases in a prehospital setting are unknown. We investigated these factors using a national trauma registry in Japan. We identified pediatric trauma patients aged ≤18 years, from January 2004 to May 2019. We categorized cases into shorter (≤13 min) and longer (>13 min) prehospital on-site time groups. We performed multivariable logistic regression analysis with multiple imputations to assess the factors associated with longer prehospital on-site time. Overall, 14,535 patients qualified for inclusion. The median prehospital on-site time was 13 min. In the multivariable logistic regression analysis, the longer prehospital on-site time was associated with higher age; suicide (Odds ratio [OR] 1.27; 95% confidence interval [CI] 1.03–1.57); violence (OR 1.74; 95%CI 1.27–2.38); higher revised trauma score, abbreviated injury scale > 3 in the spine (OR 1.25; 95%CI 1.04–1.50), upper extremity (OR 1.26; 95%CI 1.11–1.44), and lower extremity (OR 1.25; 95%CI 1.14–1.37); immobilization (OR 1.16; 95%CI 1.06–1.27); and comorbid mental retardation (OR 1.56; 95%CI 1.11–2.18). In light of these factors, time in the field could be reduced by having more pediatric emergency physicians and orthopedic surgeons available. Full article
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11 pages, 674 KiB  
Article
Bicycle Injury Prevention Education Using 360° Virtual Reality Experiences of Accidents and Computer-Based Activity
by Woosup Lee, Ju Ok Park, Sung Ok Hong and Youngtaek Kim
Children 2022, 9(11), 1623; https://doi.org/10.3390/children9111623 - 26 Oct 2022
Viewed by 1305
Abstract
Injury prevention programs for children and adolescents need to be immersive and interactive. This study assessed a bicycle injury prevention program using technology-based education based on the Activated Health Education model and evaluated its effect on environmental factor awareness and attitude toward helmet-wearing. [...] Read more.
Injury prevention programs for children and adolescents need to be immersive and interactive. This study assessed a bicycle injury prevention program using technology-based education based on the Activated Health Education model and evaluated its effect on environmental factor awareness and attitude toward helmet-wearing. Using virtual reality technology, elementary and middle school students could experience simulated bicycle accidents. It was followed by an awareness phase that included a 30-min lecture where students self-learned and discussed risk-preventive factors. Students then developed user-created content and customized helmets they were given. We assessed students before the program, immediately afterward, and one month after the program. The number of respondents who said they were aware of surrounding bicycle lanes increased from 75.3% (pre-program) to 92.5% (one month after). Those who said they wore helmets often or always rose from 14.3% (pre-program) to 32.5% (one month later). The number needed to treat helmet-wearing behavior was approximately four, meaning that four people were required to participate in the program to have an impact on one person’s helmet-wearing. We found that virtual reality and computer-based activities can help children and adolescents experience bicycle accidents, be aware of risk factors, and change their behaviors responsibly. Full article
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11 pages, 1748 KiB  
Article
Non-Fatal Drowning Risk Prediction Based on Stacking Ensemble Algorithm
by Xinshan Xie, Zhixing Li, Haofeng Xu, Dandan Peng, Lihua Yin, Ruilin Meng, Wei Wu, Wenjun Ma and Qingsong Chen
Children 2022, 9(9), 1383; https://doi.org/10.3390/children9091383 - 14 Sep 2022
Viewed by 1610
Abstract
Drowning is a major public health problem and a leading cause of death in children living in developing countries. We seek better machine learning (ML) algorithms to provide a novel risk-assessment insight on non-fatal drowning prediction. The data on non-fatal drowning were collected [...] Read more.
Drowning is a major public health problem and a leading cause of death in children living in developing countries. We seek better machine learning (ML) algorithms to provide a novel risk-assessment insight on non-fatal drowning prediction. The data on non-fatal drowning were collected in Qingyuan city, Guangdong Province, China. We developed four ML models to predict the non-fatal drowning risk, including a logistic regression model (LR), random forest model (RF), support vector machine model (SVM), and stacking-based model, on three primary learners (LR, RF, SVM). The area under the curve (AUC), F1 value, accuracy, sensitivity, and specificity were calculated to evaluate the predictive ability of the different learning algorithms. This study included a total of 8390 children. Of those, 12.07% (1013) had experienced non-fatal drowning. We found the following risk factors are closely associated with the risk of non-fatal drowning: the frequency of swimming in open water, distance between the school and the surrounding open waters, swimming skills, personality (introvert) and relationality with family members. Compared to the other three base models, the stacking generalization model achieved a superior performance in the non-fatal drowning dataset (AUC = 0.741, sensitivity = 0.625, F1 value = 0.359, accuracy = 0.739 and specificity = 0.754). This study indicates that applying stacking ensemble algorithms in the non-fatal drowning dataset may outperform other ML models. Full article
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11 pages, 247 KiB  
Article
PTSD Risk Factors and Acute Pain Intensity Predict Length of Hospital Stay in Youth after Unintentional Injury
by Anna Monica Agoston, Amina Bhatia, John C. Bleacher, Alexis Smith, Karen Hill, Susanne Edwards, Alicia Cochran and Maia Routly
Children 2022, 9(8), 1222; https://doi.org/10.3390/children9081222 - 12 Aug 2022
Viewed by 1167
Abstract
Background: Many hospitals have adopted screening tools to assess risk for posttraumatic stress disorder (PTSD) after pediatric unintentional injury in accordance with American College of Surgeons recommendations. The Screening Tool for Early Predictors of PTSD (STEPP) is a measure initially developed to [...] Read more.
Background: Many hospitals have adopted screening tools to assess risk for posttraumatic stress disorder (PTSD) after pediatric unintentional injury in accordance with American College of Surgeons recommendations. The Screening Tool for Early Predictors of PTSD (STEPP) is a measure initially developed to identify youth and parents at high risk for meeting diagnostic criteria for PTSD after injury. Acute pain during hospitalization has also been examined as a potential predictor of maladaptive outcomes after injury, including PTSD. We investigated in a retrospective cohort study whether the STEPP, as well as acute pain intensity during hospitalization, would predict maladaptive outcomes during the peri-trauma in addition to the post-trauma period, specifically length of hospitalization. Methods: A total of 1123 youths aged 8–17 (61% male) and their parents were included. Patients and parents were administered the STEPP for clinical reasons while hospitalized. Acute pain intensity and length of stay were collected through retrospective chart review. Results: Adjusting for demographics and injury severity, child but not parent STEPP total predicted length of stay. Acute pain intensity, child threat to life appraisal, and child pulse rate predicted length of stay. Conclusions: Acute pain intensity and child PTSD risk factors, most notably child threat to life appraisal, predicted hospitalization length above and beyond multiple factors, including injury severity. Pain intensity and child appraisals may not only serve as early warning signs for maladaptive outcomes after injury but also indicate a more difficult trajectory during hospitalization. Additional assessment and treatment of these factors may be critical while youth are hospitalized. Utilizing psychology services to support youth and integrating trauma-informed care practices during hospitalization may support improved outcomes for youth experiencing unintentional injury. Full article

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5 pages, 2379 KiB  
Case Report
Point of Care Ultrasound Identification of Multiple Rib Fractures in a Pediatric Patient with Osteogenesis Imperfecta Type 3
by Samuel Enci Quek, Vigil James, Leodivica Castillo, Ronald Ming Ren Tan and Gene Yong-Kwang Ong
Children 2022, 9(6), 864; https://doi.org/10.3390/children9060864 - 10 Jun 2022
Viewed by 2961
Abstract
Patients with osteogenesis imperfecta (OI) are at an increased risk of pathological rib fractures even if there is no history of trauma. Early and accurate identification of such fractures are crucial for appropriate management. We present a case of a child with OI [...] Read more.
Patients with osteogenesis imperfecta (OI) are at an increased risk of pathological rib fractures even if there is no history of trauma. Early and accurate identification of such fractures are crucial for appropriate management. We present a case of a child with OI type 3 with multiple rib fractures who presented with transient cyanosis and increased work of breathing without a history of significant trauma. The patient’s chest radiographs were reported to have a single, new right posterior fourth rib fracture and an old, healing anterior fourth rib fracture. A point-of-care ultrasound performed by the attending pediatric emergency physician revealed additional findings of refracture over the old right anterior fourth rib fracture site and a new left posterior third rib fracture. These findings of multiple and bilateral rib fractures better account for the patient’s initial presentation. This case highlights the added advantages of ultrasound over conventional chest radiographs in the evaluation and diagnosis of a tachypnoeic pediatric patient with underlying metabolic bone disease and a complex skeletal structure with multiple pathological rib fractures but no chest tenderness. Full article
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