Search Results (37)

Background: Youth with chronic rheumatologic diseases undergo medical experiences that can lead to post-traumatic stress disorder (PTSD). Understudied in pediatric rheumatology, medical PTSD can be significantly distressing and impairing. Objective: This study explored the prevalence of medical PTSD symptoms in youth with chronic inflammatory arthritis and associated factors, including pain, disease activity, mental health history, and anxiety sensitivity. Methods: A cross-sectional study of 50 youth (ages 8–18) with juvenile idiopathic arthritis (JIA) and childhood-onset systemic lupus erythematous (cSLE) was conducted at a pediatric rheumatology clinic. Participants completed self-report measures assessing post-traumatic stress symptoms (CPSS-V), pain, anxiety sensitivity (CASI), pain-related self-efficacy (CSES), adverse childhood experiences (ACEs), and fibromyalgia symptoms (PSAT). Clinical data included diagnoses, disease activity, treatment history, and demographics. Results: Forty percent had trauma symptoms in the moderate or more severe range. The 14% likely meeting criteria for probable medical PTSD were older (median 17 vs. 15 years, p = 0.005), had higher pain scores (median 4 vs. 3, p = 0.008), more ACEs (median 3 vs. 1, p = 0.005), higher anxiety sensitivity scores (median 39 vs. 29, p = 0.008), and higher JIA disease activity scores (median cJADAS-10 11.5 vs. 7.5, p = 0.032). They were also more likely to report a history of depression (71 vs. 23%, p = 0.020). No associations were found with hospitalization or injected/IV medication use. Conclusions: Medical trauma symptoms are prevalent in youth with chronic inflammatory arthritis. Probable PTSD was associated with pain and psychological distress. These findings support the need for trauma-informed care in pediatric rheumatology. Full article

Background/Objectives: Critically ill patients with acute neurological injury commonly require intubation. The true incidence of and risk for extubation failure in pediatric patients with an acute neurologic injury is not well reported, making the assessment of these patients for extubation readiness or the need for tracheostomy challenging. This study aims to better delineate the incidence of extubation failure and factors associated with the need for tracheostomy in pediatric patients surviving an acute neurologic injury. Methods: We conducted a retrospective cohort study using the Virtual Pediatric System (VPS) database of neonates, infants, children, and adolescents < 18 years of age with a neurological injury requiring intubation from 2012 to 2022. Demographic and clinical variables were compared between subjects that were successfully extubated, those with early tracheostomy placement (≤14 days), and those with late tracheostomy placement (>14 days). Results: Of the 38,810 enrolled subjects, 37,661 (97.04%) were successfully extubated, 481 (1.24%) underwent early tracheostomy, and 668 (1.72%) underwent late tracheostomy. The most common etiologies were seizures (60.6%), trauma (20.9%), and intoxication (9.1%). The successfully extubated subjects had a higher median initial GCS score (8 vs. 5 and 4, p < 0.001) and fewer extubation attempts (1 vs. 3 and 3, p < 0.001) than the tracheostomy cohorts. There was a significant difference in median ICU days between the three groups (2.52 vs. 18.3 vs. 38.3, p < 0.001). Conclusions: The majority of pediatric patients requiring intubation following an acute neurological injury can be successfully extubated. Among patients requiring a tracheostomy, those who received it early had significantly shorter ICU and hospital stays. Full article

Background/Objectives: Despite the growing burden caused by pediatric trauma, the accuracy of prehospital triage remains suboptimal due to the lack of reliable pediatric-specific tools. In this study, we aimed to evaluate the predictive validity of the reverse shock index multiplied by the Glasgow Coma Scale (rSIG) for in-hospital mortality in pediatric trauma patients and to determine appropriate age-specific rSIG cutoff values for triage use. Methods: We conducted a multicenter retrospective observational study using data from the Korean Emergency Department-Based Injury In-Depth Surveillance registry; these data covered trauma patients aged ≤18 years, spanning the period from 2011 to 2022. The rSIG was calculated using the initial vital signs and Glasgow Coma Scale scores upon arrival at the emergency department. Age groups with shared rSIG cutoffs were identified using the area under the receiver operating characteristic curve (AUC) and Akaike information criterion. Cutoff values were derived using the Youden index or further optimized to align with triage goals (<5% under-triage, <35% over-triage). Results: Among 333,995 pediatric trauma patients, the in-hospital mortality rate was 0.07%. The rSIG cutoff values derived using the Youden index showed strong predictive performance, with an AUC of 0.920 (95% CI: 0.897–0.943). The cutoff values adjusted to meet triage goals—13.3 for those aged 0–9 years, 18.4 for 10–14 years, and 20.9 for 15–18 years—achieved the best balance, with 30.94% over-triage and 9.17% under-triage. Conclusions: The rSIG is a reliable predictor of in-hospital mortality in pediatric trauma cases. We recommend using cutoff values that are optimized to meet triage goals. Further research is warranted to develop standardized methods to derive triage-appropriate cutoff values. Full article

Objectives: Social factors play a crucial role in health outcomes for pediatric patients, yet in the neurosurgery pediatric literature, these factors are rarely reported. To develop a deeper understanding of pediatric spine trauma outcomes, we investigate demographic and social factors measured by the Child Opportunity Index (COI) and Social Deprivation Index (SDI). We hypothesize that social factors predict clinical presentation, injury severity, and clinical outcomes. Methods: We conducted a retrospective cohort study of pediatric patients treated for spinal trauma at a Level 1 trauma center in Sacramento, California. We collected patient clinical data such as mechanisms of injury (MOIs), length of stay (LOS), treatment type, hospital disposition, polytrauma incidence, and follow-up attendance. Each patient’s social environment was characterized using COI and SDI metrics. Statistical comparisons were performed to assess associations between social factors and clinical outcomes. Results: Patients with worse childhood opportunity (lower COI and higher SDI) were more likely to be insured through Medi-Cal, identify as Hispanic, and experience violent MOI. Female patients were more likely to sustain polytrauma and had a higher likelihood of requiring surgical intervention. Additionally, patients from underserved communities demonstrated longer hospital stays and poorer follow-up adherence, with COI and SDI scores correlating with these disparities. Conclusion: Social disparities are associated with worse outcomes in pediatric spine trauma. We found COI and SDI to be valuable clinical metrics, motivating further research to be carried out at the state and national levels. These findings highlight health disparities in pediatric spine trauma. Full article

Background: Mild traumatic brain injury (mTBI) in the pediatric population is a significant public health concern, often associated with persistent post-concussion symptoms, including postural instability. Current tools for assessing postural control, such as the Balance Error Scoring System (BESS), lack integration with objective metrics. Incorporating force plate sensors into BESS assessments may enhance diagnostic accuracy and support return-to-play or sports decisions. This study evaluates postural performance in children with mTBI compared to controls using an instrumented BESS and examines recovery trajectories after mTBI. Methods: This prospective, longitudinal study included 31 children with mTBI (12.01 ± 3.28 years, 20 females) and 31 controls (12.31 ± 3.27 years, 18 females). Postural control was assessed using an instrumented BESS protocol during standing on a ground reaction force plate at three timepoints: within 72 h post injury (T1), at two weeks (T2), and three months after trauma (T3). Posturographic parameters derived from the displacement of the center of pressure included the ellipse area, path length, and mean velocity in the anterior–posterior and medio–lateral directions. Symptom burden was monitored using the Post-Concussion Symptom Inventory (PCSI). Results: The BESS total scores did not differ significantly between the groups at any timepoint. A significant reduction in BESS errors over time was observed exclusively in the two-legged stance on a soft surface (p = 0.047). The instrumented BESS revealed higher body swaying in the mTBI group compared to controls, particularly under demanding conditions. Significant between-group differences were most frequently observed in single-leg soft surface (38% of comparisons) and two-legged soft surface stances (29%). In those cases, path length and mean velocity differed between groups, respectively. Ellipse area did not show significant differences across conditions. Conclusions: An instrumented BESS has the potential to enhance the detection of subtle postural deficits in pediatric mTBI patients. Specifically, more demanding conditions with altered sensory-proprioceptive input and path length as an outcome measure should be focused on. This study underscores the need for tailored and age-appropriate objective and quantitative balance assessments to improve diagnostic precision in pediatric mTBI populations. Full article

Background: Pediatric radial neck fractures (pRNFs) can occur in isolation or in association with concomitant injuries. It is unknown whether the presence of associated injuries should influence the choice of treatment. The aim of this study is to assess the incidence of associated injuries in pRNF and their correlation with fracture angulation (Judet grade) or the patient’s age (under or over ten years of age). Methods: A systematic literature review was performed following PRISMA-IPD guidelines, including case series on pRNF with a minimum of five cases of children until 16 years of age. The quality assessment included a risk of bias analysis and evaluation using the MINORS criteria. Individual patient data on age, Judet classification and associated injuries were extracted from the included studies and pooled for the meta-analysis. The correlation between the presence of associated injury and the patient’s age or Judet classification was depicted in two forest plots. Results: A total of 20 articles published sufficient individual patient data (n = 371) on associated injuries. All but one were retrospective case series. Fifteen articles had MINORS scores of 8 or higher. The incidence of associated injuries was 33% (123 of 371 cases). Almost half of the associated injuries included an olecranon fracture (61/123). There was no correlation between Judet classification (p = 0.243) and incidence nor between patient age and the incidence of associated injuries (p = 0.694). Conclusions: Surgeons should be aware of potential associated injuries in over a third of pRNF cases, regardless of the patient’s age or fracture angulation. Deduction of the trauma mechanism may be a more useful tool for assessing the potential presence of associated injuries than the most frequently used fracture classification or the patient’s age. More research is needed regarding the requirements for enhanced diagnostic imaging, specific treatment or follow-up adaptations in children with pRNFs and associated injuries. Full article

Background: In the wake of Myanmar’s 2021 military coup, the University of Parma, in partnership with Myanmar and Brazilian institutions, developed an asynchronous e-learning program to sustain healthcare education amid severe disruptions. The program aimed to address urgent training needs in emergency medicine, public health management, and mental health, aligning with Sustainable Development Goals. Methods: An educational needs assessment involving 298 surveys and 10 interviews identified training priorities. Based on these findings, a four-module e-learning course was created, covering basic life support, trauma care, pediatric emergencies, and psychological assistance. The course utilized prerecorded high-fidelity telesimulations with multilingual support to ensure accessibility. Evaluation included participant satisfaction using the MSSE questionnaire and knowledge acquisition through post-module quizzes. Results: Over 750 students participated, with significant knowledge acquisition observed—60% scored 8 or higher across all modules. The MSSE questionnaire, completed by 152 students, revealed high satisfaction, with 88% agreeing that the course enhanced clinical reasoning, decision-making, and self-reflection Conclusions: This program demonstrates the value of international partnerships and e-learning in sustaining medical education during crises. High student engagement and strong learning outcomes affirm its efficacy. Future iterations will aim to improve completion rates, refine feedback mechanisms, and expand accessibility. This scalable model offers a blueprint for addressing healthcare training needs in conflict-affected and resource-limited settings, contributing to global health resilience and the achievement of Universal Health Coverage. Full article

Background: Anorexia nervosa is a serious eating disorder that mainly affects children and adolescents. Most patients present with extreme body dissatisfaction and an obsessive focus on body weight and food. Anorexia nervosa is a complex and multifactorial condition characterised by biological, psychological, and social factors. However, studies that have explored the cumulative risk that predisposes to anorexia nervosa are limited. This study aims to explore the potential risk factors for a severe form of the disease in patients affected by anorexia nervosa and to identify whether they may interact and reinforce each other, contributing to the severity of the disorder. Methods: For this study, we enrolled children and adolescents under 18 years of age hospitalised at IRCCS Bambino Gesù Pediatric Hospital, Rome, Italy, for anorexia nervosa from 1 December 2022 to 31 August 2024, identifying and analysing potential risk factors. Elevated shape and weight concerns were found in all patients. Psychiatric and neurodevelopment comorbidities were identified in 76 patients (51.35%), life stress events in 69 (46.62%), and a family history of eating and weight control behaviours in 39 (26.35%). Out of the sample size, 20.27% of patients did not live in a traditionally structured family. This study used the Kiddie-SADS-Present and Lifetime Version interview, the Coddington Life Events Scales, and the Trauma Symptom Checklist for Children questionnaires. Results: Patients with an extreme or severe index of anorexia nervosa are more likely to have multiple predisposing factors. In detail, four predisposing factors were found in 18.6% of patients with an extreme severity index, in 15.5% of those with a severe score, and in 10.3 and 10.6% of those with a moderate and mild score, respectively. Conclusions: Cumulative potential risk factors are more likely to be found in cases of severe course disease and patients hospitalised for anorexia. Prompt identification of predisposing factors and an effective plan of action are required to avoid a severe course disorder. Full article

Background: Traumatic injury is a leading cause of death and disability in children and young adults. There is a lack of evidence-based literature and guidelines on supporting families after severe child injury. This study aimed to assess the family needs and factors associated with those needs. Methods: A prospective multicenter follow-up study conducted at two Norwegian trauma centers involving children (aged 0–18 years) who sustained a moderate or severe traumatic injury with a New Injury Severity Score > 9. Sociodemographic and injury variables were recorded at baseline. The Family Needs Questionnaire—Paediatric Version, ranging from one (not at all met) to five (completely met) was completed by parents to assess the family needs at the 6-month follow-up. Bivariate logistic regression analyses were conducted to identify the factors associated with the family needs at 6 months post-injury. Results: Of the 63 children included, 38 (68% boys) with a mean age of 9.9 years (SD = 5.8) were available for follow-up. At 6 months, 82% reported needs for health information with a mean score of 3.8 (SD = 1.0), and involvement with care with a mean of 3.7 (SD = 1.2). Additionally, 71% reported emotional support needs (mean score 2.6, SD = 1.3). A higher number of injuries and a lower age of the child were significantly associated with increased odds of having more family needs. Conclusions: After moderate to severe pediatric traumatic injury, families report a need for health information, involvement in care, and emotional support. Paying attention to the number of injuries and the child’s age could help to identify families in need of information and support. Full article

Objectives: The COVID-19 pandemic has had a profound effect on the pediatric population worldwide. The consequences of the lockdown and the reallocation of hospital resources have caused notable changes in the presentation of pediatric orthopedic injuries. Through our use of patient records, we were able to display the epidemiological trends, as well as analyze the changes in the type and mechanism of various injuries. Our purpose is to further understand the considerable effects of the COVID-19 pandemic on pediatric orthopedic trauma and help guide the allocation of future healthcare resources. Methods: We conducted a retrospective cohort study on pediatric patients admitted for any orthopedic injury over a 3-year period (September 2018 to August 2021) at a Midwest level 1 trauma center. Cases were stratified into two groups based on the United States’ COVID-19 lockdown (19 March 2020): Pre-COVID-19 cases were any cases prior to the lockdown and Intra-COVID-19 which are cases following the lockdown. Numerical data and categorical variables were summarized and differences between the case groups were examined using either two-Proportion Z-Test, Independent Two-Sample t-test, Pearson’s chi-squared, or Fisher’s exact tests. Results: A total of 3179 pediatric orthopedic referrals occurred between the Pre-COVID-19 and Intra-COVID-19 study periods. We observed a general decrease in orthopedic injuries following the COVID-19 lockdowns with 1235 injuries compared to 1606 Pre-COVID-19. Patterns in the locations of injuries changed; notably, fractures of the humerus, tibia, and fibula decreased significantly (p < 0.05). Several mechanisms of injuries decreased significantly following the onset of COVID-19 including injuries caused by monkey bars, basketball, and automobiles (p < 0.01). There was a significant increase in the overall injury severity during the Intra-COVID-19 period (p < 0.05). Conclusions: Although there was a reduction in acute orthopedic trauma referrals, many injury mechanisms displayed similar trends regardless of restrictions. We clinically observed an overall increase in the severity of pediatric orthopedic injuries during the COVID-19 pandemic. Full article

Background: Blunt carotid injury (BCI) in pediatric trauma is quite rare. Due to the low number of cases, only a few reports and studies have been conducted on this topic. This review will discuss how frequent BCI/blunt cerebrovascular injury (BCVI) on pediatric patients after blunt trauma is, what routine diagnostics looks like, if a computed tomography (CT)/computed tomography angiography (CTA) scan on pediatric patients after blunt trauma is always necessary and if there are any negative health effects. Methods: This narrative literature review includes reviews, systematic reviews, case reports and original studies in the English language between 1999 and 2020 that deal with pediatric blunt trauma and the diagnostics of BCI and BCVI. Furthermore, publications on the risk of radiation exposure for children were included in this study. For literature research, Medline (PubMed) and the Cochrane library were used. Results: Pediatric BCI/BCVI shows an overall incidence between 0.03 and 0.5% of confirmed BCI/BCVI cases due to pediatric blunt trauma. In total, 1.1–3.5% of pediatric blunt trauma patients underwent CTA to detect BCI/BCVI. Only 0.17–1.2% of all CTA scans show a positive diagnosis for BCI/BCVI. In children, the median volume CT dose index on a non-contrast head CT is 33 milligrays (mGy), whereas a computed tomography angiography needs at least 138 mGy. A cumulative dose of about 50 mGy almost triples the risk of leukemia, and a cumulative dose of about 60 mGy triples the risk of brain cancer. Conclusions: Given that a BCI/BCVI could have extensive neurological consequences for children, it is necessary to evaluate routine pediatric diagnostics after blunt trauma. CT and CTA are mostly used in routine BCI/BCVI diagnostics. However, since radiation exposure in children should be as low as reasonably achievable, it should be asked if other diagnostic methods could be used to identify risk groups. Trauma guidelines and clinical scores like the McGovern score are established BCI/BCVI screening options, as well as duplex ultrasound. Full article

Background: Family members dealing with the devastating impact of a cancer diagnosis are now facing even greater vulnerability due to the COVID-19 pandemic. Alongside the already overwhelming trauma, they must also bear the distressing burden of the infection risks. The purpose of this study was to examine and explore the effects in parents of pediatric cancer patients two years after the start of the COVID-19 pandemic to compare these data with the previous data. Methods: We conducted a single-center prospective observational study, enrolling 75 parents of 42 pediatric oncology patients. Four questionnaires (IES-R; PSS; STAI-Y and PedsQL) were given to the parents 2 years after the first evaluation. Results: The bivariate matrix of correlation found a strong significant positive correlation between IES-R and PSS scores (r = 0.526, p < 0.001) as in T1. Stress symptoms (t = 0.00, p < 0.001) and levels of anxiety (trait) (t = 0.32, p < 0.001) remained unchanged; anxiety state levels appeared to have increased (t = 0.425, p < 0.001); there was a significant decrease in the PedsQL tot (t = 5.25, p < 0.001). Conclusions: The COVID-19 pandemic has influenced the levels of stress and anxiety of parents and the quality of life of patients, also correlating with the traumatic impact of the diagnosis. Full article

People with obsessive compulsive disorder (OCD) are at increased risk of developing psychotic disorders; yet little is known about specific clinical features which might hint at this vulnerability. The present study was aimed at elucidating the pathophysiological mechanism linking OCD to psychosis through the investigation of childhood trauma experiences in adolescents and adults with OCD. One hundred outpatients, aged between 12 and 65 years old, were administered the Yale–Brown Obsessive Compulsive Scale (Y-BOCS) and its Child version (CY-BOCS), as well as the Childhood Trauma Questionnaire (CTQ); Cognitive–Perceptual basic symptoms (COPER) and high-risk criterion Cognitive Disturbances (COGDIS) were assessed in the study sample. Greater childhood trauma experiences were found to predict psychotic vulnerability (p = 0.018), as well as more severe OCD symptoms (p = 0.010) and an earlier age of OCD onset (p = 0.050). Participants with psychotic vulnerability reported higher scores on childhood trauma experiences (p = 0.02), specifically in the emotional neglect domain (p = 0.01). In turn, emotional neglect and psychotic vulnerability were found higher in the pediatric group than in the adult group (p = 0.01). Our findings suggest that childhood trauma in people with OCD may represent an indicator of psychotic vulnerability, especially in those with an earlier OCD onset. Research on the pathogenic pathways linking trauma, OCD, and psychosis is needed. Full article

Introduction: Pediatric polytrauma is a complex condition with unique characteristics and requirements for early clinical care. This study aimed to analyze the injury patterns, early clinical care, and outcomes of pediatric polytrauma patients in a Level I trauma center. The focus was on evaluation between different age groups and the recognition of injuries as potential factors influencing outcomes. Methods: A prospective cohort study model of pediatric polytrauma patients (ISS ≥ 16) was conducted over a 13-year period, stratified by age groups (Group A: 0–5 years; Group B: 6–10 years; Group C: 11–15 years; and Group D: 16–18 years). A comparison of the groups was conducted to examine variations in early clinical care, trauma mechanisms, distribution of affected body regions (as per AIS and ISS criteria), and trauma-related mortality. Additionally, factors contributing to mortality were evaluated. Results: The median age of patients was 16 years, with a male predominance (64.7%). The Injury Severity Score (ISS) varied across age groups, with no significant difference. The 30-day mortality rate was 19.0%, with no significant age-related differences. Trauma mechanisms varied across age groups, with motor vehicle accidents being the most common mechanism in all age groups except 0–5 years, where falls were prevalent. Analysis of injury patterns by AIS body regions indicated that head trauma was a significant predictor of mortality (Hazard Ratio 2.894, p < 0.001), while chest, abdominal, and extremity trauma showed no significant association with mortality. Multiple regression analysis identified the ISS and preclinical GCS as valid predictors of mortality (p < 0.001 and p = 0.006, respectively). Conclusions: While age-related differences in injury severity and clinical interventions were limited, head trauma emerged as a critical predictor of mortality. Early recognition and management of head injuries are crucial in improving outcomes. Additionally, the ISS and preclinical GCS were identified as valid predictors of mortality, emphasizing the importance of early assessment and resuscitation. A tailored approach to pediatric polytrauma care, considering both age and injury patterns, might contribute to survival benefits in this vulnerable population. Full article

Background: Transcatheter arterial embolization (TAE) is an established approach for controlling hemorrhage in adults with acute abdominal and pelvic trauma. However, its application in pediatric trauma is not well established. This study aimed to evaluate the safety and effectiveness of TAE in a population of pediatric patients with blunt trauma. Methods: This retrospective study was conducted in pediatric patients (<18 years) who underwent TAE for blunt trauma between February 2014 and July 2022. The patients were categorized into subgroups based on age and body weight. Patient demographics, injury severity, transfusion requirements, and clinical outcomes were analyzed. Results: Exactly 73 patients underwent TAE. Technical success was achieved in all patients (100%), and clinical success was achieved in 83.6%. The mortality and complication rates were 4.1% and 1.4%, respectively. The mean duration of hospitalization was 19.3 days. Subgroup analysis showed that age, body weight, and sex did not significantly affect clinical success. The injury severity score and transfusion requirement were predictors of clinical success, with lower values associated with better outcomes. Conclusions: TAE is effective and safe for managing blunt pediatric trauma in younger and lighter patients. Injury severity and transfusion requirement are predictors of clinical success. Full article