Persistent post-concussive syndrome in children after mild traumatic brain injury is prevalent and vastly underdiagnosed.

Data on epidemiology and prognosticators of persistent post-concussion syndrome (PPCS) after mild traumatic brain injury (mTBI) in the pediatric population is scarce. The aim of this study was to evaluate the prevalence of PPCS in children after mTBI and to identify clinical variables in children who are at high risk for developing PPCS. A multicenter, retrospective matched cohort in which PPCS symptoms were evaluated in children 8-15-year-old, 6-60 months after being admitted to the emergency department because of mTBI. The control group included children admitted to the emergency department because of uncomplicated distal radius fractures. The children's guardians were interviewed for the presence of PPCS symptoms using the "Rivermead Post-Concussion Questionnaire". A multivariable logistic regression model was used to identify predictors of PPCS. Two-hundred and five children were included in the mTBI group and 205 in the control. The median time from the injury was 33.5 months in the mTBI group and 33.8 in the control. The prevalence of PPCS in the mTBI group was 25.3% and PPCS like symptoms in the control was 2.4%, p < 0.001. Within the 6-60 months period, the PPCS prevalence was not influenced by the time that elapsed from the injury. In the mTBI group, motor vehicle accidents and adolescence were found to be risk factors for PPCS. PPCS is underdiagnosed in the pediatric population and 25% of children admitted to the ED due to mTBI may suffer from PPCS. Screening guidelines should be implemented to identify and properly treat these children.

Fever response to ibuprofen in viral and bacterial childhood infections.

OBJECTIVE: to compare the antipyretic effects of ibuprofen in febrile children with serious bacterial infections (SBI), and children with a presumed viral infection. METHODS: A prospective cross- sectional study was conducted in a pediatric Emergency department between October 2018 and March 2020 for children aged 3 months to 4 years with a rectal temperature ≥ 38.5 °C. Patients received 10 mg/kg of ibuprofen oral suspension. Rectal temperature was measured 60 and 120 min after administration. Laboratory and imaging evaluations were performed for each study participant in order to identify serious bacterial infection. RESULTS: Ninety patients were included, of which 18 were diagnosed with serious bacterial infections. There was no significant difference in age, fever at presentation and duration of fever between the groups. No significant difference was noted in body temperature reduction at 60 and 120 min after ibuprofen administration (1.09 ± 0.75 °C vs 0.89 ± 0.58 °C, mean difference -0.12 °C, 95% CI -0.54-0.15 °C; 1.85 ± 0.53 °C vs 1.78 ± 0.83 °C, mean difference - 0.07 °C, 95% CI -0.49-0.36 °C, in the SBI and non-SBI groups respectively). CONCLUSION: Fever response to Ibuprofen administration is not indicative of serious bacterial infections in children under 4 years of age. Larger prospective studies are required to define whether the lack of response to Ibuprofen has any impact on the management of febrile children.

Complementary and alternative medicine among hospitalized pediatric patients.

OBJECTIVES: To estimate the prevalence and describe the characteristics of complementary and alternative medicine (CAM) use among hospitalized children, and to discover the awareness of medical staff regarding CAM use. DESIGN/SETTING: Parents of children aged 0-18 years admitted to the Pediatric Division at Assaf Harofeh Medical Center in Israel between January and July of 2015 (n=146) were provided a questionnaire regarding socio-economic status and evaluating the CAM use. The medical charts of the participants were reviewed in order to establish whether or not CAM use was documented. RESULTS: Of those who completed the questionnaire, 78 (54.3%) were using CAM. The major indications for CAM use were colic and teething. CAM use was advised by the family in 44.9%, physician 34.6%, pharmacist 34.6%, friends 30.8%, previous experience 23.1, advertisements 18%, nurses 6.4%, and homeopaths 2.6%. The family physician was aware of CAM use was in 42%. During the admission, only 5 patients were asked about CAM use (3.4%) by the medical staff. Reviewing the medical charts revealed there was no documentation of CAM use in any of the participants. Socio-demographic analysis of our population revealed no differences between users and non users of CAM, but significant differences in belief in CAM (p=0.018) were found. CAM use was age related; the older the child the less the use (p=0.010). CONCLUSION: CAM use is common among hospitalized pediatric patients and is often overlooked by the medical staff. CAM use should be included in the medical history.