Diffuse axonal injury on magnetic resonance imaging and its relation to neurological outcomes in pediatric traumatic brain injury.

OBJECTIVE: Diffuse axonal injury (DAI), a frequent consequence of pediatric traumatic brain injury (TBI), presents challenges in predicting long-term recovery. This study investigates the relationship between the severity of DAI and neurological outcomes in children. METHODS: We conducted a retrospective analysis of 51 pediatric TBI patients diagnosed with DAI using Adam's classification. Neurological function was assessed at 2, 3, and 6 weeks, and 12 months post-injury using the Pediatric Glasgow Outcome Scale-Extended (PGOSE). RESULTS: PGOSE scores significantly improved over time across all DAI grades, suggesting substantial recovery potential even in initially severe cases. Despite indicating extensive injury, patients with DAI grades II and III demonstrated significant improvement, achieving a good recovery by 12 months. Although the initial Glasgow Coma Scale (GCS) score did not show a statistically significant association with long-term outcomes in our limited sample, these findings suggest that the severity of DAI alone may not fully predict eventual recovery. CONCLUSIONS: Our study highlights the potential for significant neurological recovery in pediatric patients with DAI, emphasizing the importance of long-term follow-up and individualized rehabilitation programs. Further research with larger cohorts and extended follow-up periods is crucial to refine our understanding of the complex relationships between DAI severity, injury mechanisms, and long-term neurological outcomes in children.

Appendicitis Post Fall in the Pediatric Population: A Case Report.

The appendix is a small, finger-sized tubular pouch that extends from your large intestine. Regardless, the physiology of the appendix is still unclear. There are several factors that cause appendicitis, such as infection, underlying tumor, constipation, and trauma. Symptoms of right lower quadrant abdominal pain, nausea, anorexia, and fever, as well as physical signs such as rebound tenderness and McBurney point/sign, are typical of non-traumatic acute appendicitis. On the other hand, a thorough history and physical examination are paramount for an accurate diagnosis of acute traumatic appendicitis. If the history and physical examination are inconclusive, further evaluation with ultrasonography or computed tomography (CT) is advised. Upon reaching an accurate diagnosis, the course of treatment involves an appendectomy and intravenous antibiotics. This case describes a patient who suffered blunt traumatic abdominal injury from a fall resulting in acute appendicitis. For pediatric patients who complain of abdominal pain and present to the emergency department (ED), appendicitis should be on the differential diagnosis list, even if the patient's symptoms started after blunt abdominal trauma. Due to the rarity of appendicitis after trauma, rapid identification necessitates a high index of suspicion.