Background: The presentation of minor head trauma warrants immediate and accurate diagnosis for early clinical management among children. Computed Tomography is the gold standard tool for the diagnosis of Traumatic Brain Injury (TBI) among the children. The timing of presentation may have a significant role in predicting the incidence of TBI. This study was done to compare the CT findings among children who presented within and after 24 hours with minor head trauma.Methods: This cross-sectional study was carried out among 992 children between 2-15 years reporting with a history of head injury. All the participants were clinically examined, and relevant history of type of injury and timing of presentation was recorded. CT scan was taken as per PECARN criteria. Data was entered and analysed using SPSS ver 15 software.Results: Majority of the participants belonged to 6-10 years of age (45.2%) and were males (58.5%). About 81.7% of the participants presented within 24 hours. The overall prevalence of TBI among the study participants was 58.6% [55.5-61.6].It was observed that hematoma predominantly presented after 24 hours (74.2%) and majority of the falls presented after 24 hours (92.8%).Patients who presented after 24 hours were at increased risk of presenting as TBI (67.03%) compared to those presenting within 24 hours (56.8%;p<0.05).Conclusions: This study has emphasized the need for including the timing of presentation as a key factor for facilitating early diagnosis and rapid case management of pediatric head trauma.
BACKGROUND Hirschsprung's disease is the commonest cause of functional intestinal obstruction in children. Majority of children with Hirschsprung's disease will have delayed passage of meconium in newborn period with abdominal distension and older children present with chronic constipation. This study describes the clinical characteristics and outcome of management of this disease in our setting where frozen section facilities are difficult. MATERIALS AND METHODS A total of three hundred and nineteen patients were analysed over twelve years' duration; stage I 147 patients and stage II 172 patients. The presentation, diagnostic investigations, operative management and complications were described. Study Design-This is a retrospective study with record based analysis. RESULTS Patients of Hirschsprung's disease both in stage I (Colostomy) and stage II (Pull-through) developed significant number of complications with severity ranging from minor to major. CONCLUSION Although complications are common, majority of the complications are manageable and attain a socially satisfactory bowel habit.
Background: Sepsis is defined as systemic inflammatory response syndrome in the presence of a suspected or known invasive infection and septic shock is defined as sepsis and cardiovascular organ dysfunction which persists even after initial fluid resuscitation. It is important to identify the risk of progression of sepsis to septic shock and death in the pediatric age group in order to prevent mortality. Methods: This cohort study was carried out among 142 children aged between one month and 18 years who were diagnosed with sepsis in the emergency room (ER). All the hemodynamic and laboratory parameters were evaluated. The participants were followed up for a period till recovery/death. Particulars related to the management of the cases in terms of fluid resuscitation, inotropes and antibiotics were also documented.Results: Majority of the participants were aged between 1-10 years and were males. There was a statistically significant difference in the temperature, total leukocyte count and other biochemical parameters between survivors and non survivors (p<0.05). Initiation of antibiotics within one hour was significantly higher among the survivors compared to the non survivors (p<0.05).Conclusion: There is a need for immediate and early detection of abnormalities in the clinical and laboratory parameters in order to prevent mortality due to septic shock in the pediatric emergency room.
Background: Traumatic Brain Injury (TBI) is one of the most common cause of Emergency Room (ER) visits in the pediatric age group. Severe TBI can result in impairment of higher cognitive functions and can also limit physiological functions like motor, speech and emotional problems. This study was carried out to evaluate the outcomes of TBI among pediatric patients presenting in ER. Methods: This cross-sectional study was carried out among 175 pediatric patients visiting the emergency room with a diagnosis of traumatic brain injury. Patient with moderate to severe traumatic head injury within 72 hours and those aged 1-15 years were included. Glasgow coma scale was used to assess and grade the severity of the TBI. Glasgow Outcome Scale was used to grade the outcomes following TBI. Results: As per the Glasgow Outcome Scale (GOS), majority of the participants were graded with mild disability and good recovery (64%), while 6 patients were graded to be dead and 4.6% of the participants were graded to be in vegetative state. In this study, significant correlation between severity of the TBI and its outcome. Moderate TBI was associated with better outcomes compared to severe TBI. The association was found to be statistically significant (p<0.0001). Conclusion: Considering the impact of specific causes of TBI namely motor vehicle accidents and fall from height, there is a need for implementation of rigorous legislations which can minimize the risk for such accidents involving the pediatric age groups. It is essential to create safe public places, which are not only utility based, but also enable vulnerable age groups access them with minimal risk.
Background: The head injuries are unique in the pediatric age group, owing the distinctive characteristics in the anatomy and physiology of the brain, characterized by neuroplasticity. Several factors like physiological changes, etiology, management and its outcome pertaining to TBI needs to be evaluated to probe the potential for being a preventable risk factor. This study was carried out to assess the pattern of presentation of Traumatic Brain Injury (TBI) among pediatric age group visiting the emergency room. Methods: This cross-sectional study was carried out among 175 pediatric patients visiting the emergency room with a diagnosis of traumatic brain injury. Patient with moderate to severe traumatic head injury within 72 hours and those aged 1-15 years were included. Glasgow coma scale was used to assess and grade the severity of the TBI. Results: Majority of the participants (70.9%) belonged to moderate TBI and 29.1% belonged to severe TBI. Motor vehicle accidents were predominantly associated with severe injury (50%), fall from a height was associated more with moderate TBI. This association was found to be statistically significant (p<0.0005). Conclusion: Considering the impact of specific causes of TBI namely motor vehicle accidents and fall from height, there is a need for implementation of rigorous legislations which can minimize the risk for such accidents involving the pediatric age groups.
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