Explore the vast range of titles available.

Prior studies suggest that concussion may lead to an increased risk of a subsequent time-loss sport-related injury, but the mechanisms responsible are unknown. We measured the symptom and dual-task gait outcomes for athletes initially post-concussion and after clinical recovery. Participants then self-reported any additional injuries incurred in the year after their concussion. Forty-two athletes (52% female, mean age = 16.8 ± 3.2 years) completed the study. They underwent a dual-task gait evaluation and symptom inventory within 21 days post-concussion, and again after they were deemed clinically recovered. Approximately one year later, participants documented if they had sustained any subsequent sport-related injuries. The repeated measures analysis of variance (ANOVA) was used to evaluate changes in dual-task gait and symptoms across time and between groups. A significant group*time interaction (p = 0.02) indicated that the group that went on to sustain a subsequent time-loss injury after returning to sports (n = 15) demonstrated significant average walking speed dual-task cost worsening across time (−17.9 ± 9.1% vs. −25.1 ± 12.5%; p = 0.007). In contrast, the group that did not sustain an additional injury walked with consistent dual-task cost values across time (−25.2 ± 9.2% vs. −24.6 ± 8.4%; p = 0.76). Symptoms improved for all participants (main effect of time, p < 0.001; Post-Concussion Symptom Scale [PCSS] = 25.0 ± 16.9 vs. 2.8 ± 7.5; p < 0.001), but did not differ between groups (p = 0.77). Significant dual-task gait cost worsening throughout concussion recovery was associated with time-loss injuries during sports in the year after a concussion. These findings indicate that worsening ability to execute a concurrent gait and cognitive task may relate to the risk of incurring an injury during sports after clinical concussion recovery.

Background Girls’ pelvic fracture bladder neck avulsion and urethral rupture is rare however it causes great morbidity. The management is complex and not standard yet. We report our experience and a technique of bladder neck reconstruction with anterior bladder wall flap. Methods We retrospectively analysed data of 5 girls with pelvic fracture bladder neck avulsion and urethral rupture admitted to our institution from July 2017 to October 2019. They all came to our institution with a suprapubic tube. Patients’ trauma was all initially treated at other hospitals, 4 had suprapubic cystotomy and 1 had urethral realignment. One girl also had three other urethroplasties at other hospitals. We took pubectomy, posterior ureth roplasty and bladder neck reconstruction with anterior bladder wall flap in these 5 girls. Post-operative assessments included voiding cystourethrography, uroflowmetry and urethroscopy after urethral catheter removal. Verbal consent to participate was obtained from the parent or legal guardian of the children. Results Operation time ranged from 120 to 180 min. Follow-up time is 12 to 27 months. Uroflowmetry showed that maximum urine flow rate improved significantly. Cystourethrography indicated good continuity of the urethra. Two girls had urinary incontinence postoperatively but were continent 3 months later. One patient developed vesical-abdominal fistula and got repaired by surgery 6 months later. She was continent ever since. Other complications were not observed during the follow-up period. Conclusions Our method of bladder neck reconstruction using bladder flap as a patch is feasible and provides good continence, especially for those with serious bladder neck avulsion and urethral rupture caused by extensive trauma and those who had posttraumatic urethral distraction needed second repair.

Spleen injuries are among the most frequent trauma-related injuries. At present, they are classified according to the anatomy of the injury. The optimal treatment strategy, however, should keep into consideration the hemodynamic status, the anatomic derangement, and the associated injuries. The management of splenic trauma patients aims to restore the homeostasis and the normal physiopathology especially considering the modern tools for bleeding management. Thus, the management of splenic trauma should be ultimately multidisciplinary and based on the physiology of the patient, the anatomy of the injury, and the associated lesions. Lastly, as the management of adults and children must be different, children should always be treated in dedicated pediatric trauma centers. In fact, the vast majority of pediatric patients with blunt splenic trauma can be managed non-operatively. This paper presents the World Society of Emergency Surgery (WSES) classification of splenic trauma and the management guidelines.

There is limited literature analyzing pediatric hurdle injuries based on sex and age. This study compares hurdle-related injury types, injured body parts, and injury mechanisms by age and sex in pediatrics. Hurdle-related injury data from the National Electronic Injury Surveillance System were used to retrospectively review the injuries of hurdlers 18 years and under. Differences in injured body parts, injury types, and mechanisms were analyzed by age (pre-high school vs. high school) and sex (male vs. female). A total of 749 cases were extracted. Fractures were more common in pre-high schoolers (34.1% vs. 21.5%, p = 0.001), while more sprains were identified in high schoolers (29.6%) than pre-high schoolers (22.8%, p = 0.036). Males suffered more fractures than females (35.1% vs. 24.3%, p = 0.001). Females sustained more joint sprains (29.1% vs. 21.0%, p = 0.012) and contusions/hematomas (12.7% vs. 7.5%, p = 0.020). Ankle injuries were more common in females (24.0%) than males (12.0%, p = 0.001), while wrist injuries were more prevalent in males (11.7% vs. 7.2%, p = 0.034). The most common injury mechanism was apparatus-related, with no differences based on age or sex. Injury types and injured body parts differed depending on age and sex in pediatric hurdle injuries seen in emergency departments. These findings may be helpful for injury prevention and medical care for pediatric hurdlers.

A significant number of adolescent athletes throughout the world participate in various throwing-dominant sports, including but not limited to baseball, cricket, handball, softball, track and field throwing events, and water polo. Due to the unique stresses placed on the throwing arm and entire body in these sports, a robust volume of literature has highlighted concerns about sport specialization in these athletes and an associated increased risk of injury, particularly to the dominant shoulder and elbow, with sport specialization. This review will highlight the evidence-based literature for this athletic niche, focusing on risk factors for injury, national and international organizations' recommendations for limiting overuse injuries, principles of conditioning and rehabilitative programs, and potential future areas of research to curb the growing incidence of throwing-related injuries among adolescent throwing athletes.

In the largest sample studied to date, white matter microstructural trajectories and their relation to persistent symptoms were examined after pediatric mild traumatic brain injury (mTBI). This prospective, longitudinal cohort study recruited children aged 8–16.99 years with mTBI or mild orthopedic injury (OI) from five pediatric emergency departments. Children's pre‐injury and 1‐month post‐injury symptom ratings were used to classify mTBI with or without persistent symptoms. Children completed diffusion‐weighted imaging at post‐acute (2–33 days post‐injury) and chronic (3 or 6 months via random assignment) post‐injury assessments. Mean diffusivity (MD) and fractional anisotropy (FA) were derived for 18 white matter tracts in 560 children (362 mTBI/198 OI), 407 with longitudinal data. Superior longitudinal fasciculus FA was higher in mTBI without persistent symptoms relative to OI, d (95% confidence interval) = 0.31 to 0.37 (0.02, 0.68), across time. In younger children, MD of the anterior thalamic radiations was higher in mTBI with persistent symptoms relative to both mTBI without persistent symptoms, 1.43 (0.59, 2.27), and OI, 1.94 (1.07, 2.81). MD of the arcuate fasciculus, −0.58 (−1.04, −0.11), and superior longitudinal fasciculus, −0.49 (−0.90, −0.09) was lower in mTBI without persistent symptoms relative to OI at 6 months post‐injury. White matter microstructural changes suggesting neuroinflammation and axonal swelling occurred chronically and continued 6 months post injury in children with mTBI, especially in younger children with persistent symptoms, relative to OI. White matter microstructure appears more organized in children without persistent symptoms, consistent with their better clinical outcomes. In the largest sample studied to date, white matter microstructural trajectories and their relation to persistent symptoms were examined after pediatric mild traumatic brain injury (mTBI). White matter microstructural changes suggesting neuroinflammation and axonal swelling continued 6 months post‐injury in children with mTBI, especially in younger children when symptoms are persistent, relative to OI. White matter microstructure appears more organized in children without persistent symptoms, consistent with better clinical outcomes.

Prescription opioid misuse has become a leading cause of unintentional injury and death among adolescents and young adults in the United States. However, there is limited information on how adolescents and young adults obtain prescription opioids. There are also inadequate recent data on the prevalence of additional drug abuse among those misusing prescription opioids. In this study, we evaluated past-year prevalence of prescription opioid use and misuse, sources of prescription opioids, and additional substance use among adolescents and young adults. This was a retrospective analysis of the National Survey on Drug Use and Health (NSDUH) for the years 2015 and 2016. Prevalence of opioid use, misuse, use disorder, and additional substance use were calculated with 95% confidence intervals (CIs), stratified by age group and other demographic variables. Sources of prescription opioids were determined for respondents reporting opioid misuse. We calculated past-year prevalence of opioid use and misuse with or without use disorder, sources of prescription opioids, and prevalence of additional substance use. We included 27,857 adolescents (12-17 years of age) and 28,213 young adults (18-25 years of age) in our analyses, corresponding to 119.3 million individuals in the extrapolated national population. There were 15,143 respondents (27.5% [95% CI 27.0-28.0], corresponding to 32.8 million individuals) who used prescription opioids in the previous year, including 21.0% (95% CI 20.4-21.6) of adolescents and 32.2% (95% CI 31.4-33.0) of young adults. Significantly more females than males reported using any prescription opioid (30.3% versus 24.8%, P < 0.001), and non-Hispanic whites and blacks were more likely to have had any opioid use compared to Hispanics (28.9%, 28.1%, and 25.8%, respectively; P < 0.001). Opioid misuse was reported by 1,050 adolescents (3.8%; 95% CI 3.5-4.0) and 2,207 young adults (7.8%; 95% CI 7.3-8.2; P < 0.001). Male respondents using opioids were more likely to have opioid misuse without use disorder compared with females (23.2% versus 15.8%, respectively; P < 0.001), with similar prevalence by race/ethnicity. Among those misusing opioids, 55.7% obtained them from friends or relatives, 25.4% from the healthcare system, and 18.9% through other means. Obtaining opioids free from friends or relatives was the most common source for both adolescents (33.5%) and young adults (41.4%). Those with opioid misuse reported high prevalence of prior cocaine (35.5%), hallucinogen (49.4%), heroin (8.7%), and inhalant (30.4%) use. In addition, at least half had used tobacco (55.5%), alcohol (66.9%), or cannabis (49.9%) in the past month. Potential limitations of the study are that we cannot exclude selection bias in the study design or socially desirable reporting among participants, and that longitudinal data are not available for long-term follow-up of individuals. Results from this study suggest that the prevalence of prescription opioid use among adolescents and young adults in the US is high despite known risks for future opioid and other drug use disorders. Reported prescription opioid misuse is common among adolescents and young adults and often associated with additional substance abuse, underscoring the importance of drug and alcohol screening programs in this population. Prevention and treatment efforts should take into account that greater than half of youths misusing prescription opioids obtain these medications through friends and relatives.

BACKGROUND: Eye injury is a leading cause of unilateral childhood blindness. The purpose of this research was to study the management and visual outcome of pediatric eye injuries necessitating hospitalization and surgical repair. MATERIALS AND METHODS: This is a retrospective study of children having eye injury that needed surgical repair over the period of 2012 and 2017. Demographic data, place of occurrence, activity at the time of injury, place and cause of injury, presenting signs, surgical interventions, visual acuity (VA) before and after surgery, and causes for vision limitations were studied. RESULTS: Thirty-nine eyes of children were surgically treated. The mean (range) age of the patients was 3 years (1-15 years). Nearly 61.5% were males. Almost 80% of injuries occurred at home and while playing (71.8%). Trauma with sharp objects (35.8%) was the most common cause of injury. Majority presented to the hospital in <6 h (89%), mainly with eye pain (95%). Corneal laceration (53.8%), traumatic cataract (15.3%), and foreign body (15.3%) were the most common clinical findings. Twenty-one (53.8%) eyes sustained open-globe injuries. Fifteen percent had vision of 20/200 or worse at follow-up. The VA improved significantly at follow-up (P < 0.05). The major cause of vision limitation was the cornea (33%). CONCLUSIONS: Eye injury is a major cause of vision loss in children. Despite early presentation to our hospital and prompt interventions, significant number of our pediatric patients sustained limited VA in ruptured globe injuries.

Despite its high risk of injury, many people are still favor trampolining. However, currently there is no consensus as to which type of trampoline and which type of participant is more likely to have a trampoline related injury that will require surgical management. This systematic review and meta-analysis aims to assess and compare the factors that cause trampoline injuries requiring surgical treatment. These include the place of the trampoline (park versus home), size of the trampoline (full versus mini), the age of the participant (child versus adult) and the sex of the participant (male versus female). The clinical outcomes measured are surgical management after trampoline injury. This systematic review was conducted according to the PRISMA guidelines. Relevant studies that reported surgery after trampoline injury of either group were identified from Medline and Scopus from inception to May 14, 2019. Sixteen studies were included for the analysis of surgery after trampoline injury; a total of 4491 and 1121 patients were treated conservatively and surgically. The total surgery rate per patient was 31% (95% CI: 16, 46%) in all patients. The surgery rate was 0.3 (95% CI: 0.03, 0.58) and 0.06 (95% CI: 0.04, 0.09) in the full and mini size trampoline groups. There were 0.36 (95% CI: 0.06, 0.67) and 0.11 (95% CI: 0.0, 0.22) in the park and home trampoline groups. The surgery rates were 0.33 (95% CI: 0.14, 0.53), 0.24 (95% CI: 0.07, 0.11), 0.49 (95% CI: 0.47, 0.51) and 0.38 (95% CI: 0.22, 0.53) in children, adults, females and males respectively. Indirect meta-analysis shows that full size trampolines provided a 6.0 times higher risk of surgery (95% CI: 3.7, 9.7) when compared to mini size trampolines. Park trampolines had a higher risk of surgery of 2.17 (95% CI: 1.70, 2.78) when compared to home trampolines. In terms of age and sex of participants, there value was significantly higher at 1.65 (95% CI: 1.35, 2.01) and 1.54 (95% CI: 1.36, 1.74) in children compared to adults and females compared to males. From all the statistical data we summarized that the full size trampoline injuries have a 6 times higher risk of requiring surgery when compared to mini size trampoline injuries. Park trampoline use carries a 2 times higher risk of requiring surgery when compared to home trampoline use. In terms of age and sex of the participant, there is a 1.5 times significantly higher risk of injury in children compared to adults, and females when compared to males. In trampoline related injuries, full size, park trampoline, children and females had higher surgery rates when compared to mini size, home trampoline, adult and male majority in indirect meta-analysis methods.

BackgroundThe number of EDs visit is on the increase, and the pressure on EDs is of significant concern worldwide. The usage of EDs by parents of children with minor illness is an important and still unresolved problem causing a burden to healthcare services. The aim of this study was to review the literature to summarise parental reasons for visiting ED for children with minor illness.MethodSeven electronic databases (Medline, Embase, PsycINFO, CINAHL, PubMed, Web of Science and Scopus) were comprehensively searched during a 2-week period in August 2016 and updated between 11 and 20 June 2018. The study selection process was undertaken independently by two authors. Qualitative and quantitative studies that focused on the reasons for parents of children with minor illness to attend an ED were included. Studies were assessed for quality and data were analysed by means of narrative synthesis.ResultsTwenty-four studies were included. Eleven studies employed quantitative methods, eleven studies used qualitative methods and two studies used mixed methods. Parental reasons for using ED included perceived urgency, ED advantages (eg, faster service, superior ED resources and efficiency), difficulties with getting a general practitioner appointment, lack of facilities in primary healthcare services, lack of health insurance, reassurance, convenience and access.ConclusionThis review identified some of the reasons why parents bring their children to the ED for minor illnesses highlighting the multifaceted nature of this problem. Understanding parental reasons behind their choice to use the ED may help us better design targeted interventions to reduce unnecessary ED visits and alleviate the burden on overstretched healthcare services. This review may help inform emergency care policy makers, researchers and healthcare staff to understand parents’ reasons for visiting the ED, to better meet their healthcare needs.