Comparison of Resource Utilization and Length of Hospitalization Between Overweight and Healthy-Weight Pediatric Trauma Patients Presenting to a Pediatric Emergency Department With Moderate to Severe Injury: A Prospective Study.

OBJECTIVES: Our study aimed to compare overweight and healthy-weight pediatric trauma patient outcomes, specifically with respect to hospital length of stay and resource utilization. We hypothesized that overweight pediatric trauma patients would have increased hospital length of stay and radiographic study use compared with their healthy-weight counterparts. METHODS: This was a prospective, observational, cohort study of pediatric trauma patients aged 2 to 19 years presenting to an urban pediatric emergency department over a period of 1 year. Using measured height and weight values, body mass index (BMI) for age was calculated and plotted on the Centers for Disease Control and Prevention BMI-for-age growth charts. Patients were followed up throughout their hospitalization, and the following items were recorded: trauma alert level, mechanism of injury, age, sex, race, Glasgow Coma Scale score, total number of days in hospital, total number of intensive care unit days, total number of radiographs obtained, total number of computed tomography scans obtained, and mechanism of injury. RESULTS: Our study population included 109 subjects. The mean age of the subjects was 9.7 years. The number of patients meeting the definition of obese (BMI for age ≥95%) was 15, or 14% of the total study population. There was no significant difference between the overweight cohort and the healthy-weight cohort found among any of the variables recorded and analyzed. CONCLUSIONS: Although there are many chronic conditions in children associated with obesity, in the case of trauma, it does not seem to be a strong concern. A continued focus on preventing and reversing childhood obesity for other physical and mental health outcomes may be more important.

Abdominal Pain Caused by a Potentially Fatal Attraction.

Abdominal pain is a challenging presentation in children. Examination findings and etiology vary greatly, spanning a vast spectrum from flatulence to frank peritonitis with septic shock. Here, we discuss a 10-year-old boy with 24 hours of progressively worsening lower abdominal pain, nausea, and subjective fevers. History and physical examination findings were consistent with appendicitis. However, physicians were surprised when the single-view abdominal radiograph showed an unanticipated, somewhat perplexing discovery.

Atopic dermatitis is more severe in children over the age of two who have an increased body mass index.

AIM: Childhood obesity increases the risk of developing atopic dermatitis, but no objective measuring tool has been used to determine whether it also affects the severity. Our aim was to determine whether an association existed between increased body mass index (BMI) or weight for length and severity of atopic dermatitis, as measured by the SCORing Atopic Dermatitis (SCORAD) index. METHODS: Children with atopic dermatitis who presented to the emergency department at an urban children's hospital (n = 104) were assessed using the SCORAD index. We assessed the relationship between BMI percentile or weight for length percentile, based on age, and atopic dermatitis severity, using single-variable multinomial logistic regression with odds ratios. RESULTS: A significant association was found between BMI >24 and atopic dermatitis severity for children older than 2 years. When analysed separately, a significant association between BMI percentile and SCORAD severity was found in boys but not in girls. CONCLUSION: These data suggest that the severity of atopic dermatitis is associated with increased BMI percentile in children older than 2 years, although this association was not apparent in younger ages using weight for length. Our results indicate the need for new avenues in the prevention and treatment of these entities.

Next-generation sequencing to generate interactome datasets.

Next-generation sequencing has not been applied to protein-protein interactome network mapping so far because the association between the members of each interacting pair would not be maintained in en masse sequencing. We describe a massively parallel interactome-mapping pipeline, Stitch-seq, that combines PCR stitching with next-generation sequencing and used it to generate a new human interactome dataset. Stitch-seq is applicable to various interaction assays and should help expand interactome network mapping.

Neonatal scalp abscess: is it a benign disease?

BACKGROUND: Neonatal scalp abscesses are a rare but potentially very serious condition. OBJECTIVES: This report serves to demonstrate meningitis as a potential complication of neonatal scalp abscess. In addition, we review the current literature on the subject and comment on the most appropriate evaluation and treatment. CASE REPORT: We describe six cases of neonatal scalp abscesses with one complication of enterococcal meningitis. CONCLUSION: The emergency practitioner should recognize that a neonate with a scalp abscess needs to be evaluated for potential serious complications and treated empirically to cover for organisms of vaginal origin.

Application of electronic surveillance and global information system mapping to track the epidemiology of pediatric pedestrian injury.

OBJECTIVE: To compare the epidemiology of pediatric pedestrian injury in Jacksonville, FL to national trends, to analyze geographic distribution of these injuries, and to analyze pedestrian injury severity trends over time. METHODS: Hospital emergency department and trauma registry data were analyzed for calendar year 2002 to define the incidence by age of vehicular pedestrian injury (Classification of Diseases--9th Revision--Clinical Modification E-code 814.7) in children less than 18 years old. The group was then stratified into the cohort living in the urban center (health zone 1-HZ1), and all other children in the region served by our state designated regional pediatric trauma referral center. To identify specific areas of cluster within and outside HZ1, FL Department of Highway Safety and Motor Vehicles (DHSMV) pedestrian crash data were analyzed for years 2002 to 2004. Global information system (GIS) mapping was performed based upon crash data geographic information. A recently deployed electronic injury surveillance system that combines both emergency department and trauma registry databases was then used to perform a similar analysis for calendar year 2006, which was the second of a 2-year program of enhanced prevention education specifically focused on the children and families of HZ1. This data were complied with 2006 DHSMV data to identify any decrease or change in GIS distribution of 2006 crashes compared with those of 2002. RESULTS: The 71 total crashes encountered during the 2002 included 21 children (30%) with injury severity that required admission to the trauma service. Children from HZ1 represented 34% of the 2002 cohort (N = 24). Comparison of victim age distribution to a national sample recorded in the National Pediatric Trauma Registry demonstrated a statistically significantly higher proportion of adolescents injured in Jacksonville. Epidemiologic evaluation of a larger sample of DHSMV data for 2002 to 2004 identified 236 crashes, in which males constituted a majority (64.4%). Fall was the largest season with 30.9% of incidents. Most crashes occurred from 1 pm to 8 pm (61.4%) and were distributed predominantly during weekdays. A major portion of crashes occurred at nonintersections (40.3%). As indicated in the 2002, cohort adolescents aged 11 to 15 were the largest age group struck (35% for 2002, 48% for 2002-2004). GIS mapping revealed a high density of crashes in the urban core of northwest Jacksonville. Data from 2006 identified 74 children struck by vehicles, including only 9 (12%) who required admission to the trauma service. The proportion of HZ1 victims remained the same (35%); however no HZ1 child required admission to the trauma service. The overall incidence was unchanged either in age distribution or occurrence within HZ1. Comparison of 2006 GIS data to 2002 highlights a persistence of pedestrian incidents in north and west components of urban Jacksonville. Analysis of 2006 DHSMV data reveal similar epidemiologic trends to 2002 to 2004. CONCLUSIONS: Although Jacksonville is similar to national trends in terms of gender, hour, day, and location of pedestrian injury, it differs from previous reports in terms of seasonality and the high proportion of adolescents struck. The effect of enhanced education appears to have diminished injury severity, although comparison of GIS plots clearly demonstrates that effective control will require changing environmental factors. Moreover, this report mandates further investigation and prevention efforts specifically targeting adolescents in urban areas.

Clinical Applications of Procalcitonin in Pediatrics: An Advanced Biomarker for Inflammation and Infection-Can It Also Be Used in Trauma?

Background. Procalcitonin is a small molecular peptide that has gained increased support as an adjunct diagnostic marker of infection in the adult population; the concordant body of evidence for the use of procalcitonin in pediatric populations is far less complete. Objectives. Our objective is to review the current evidence supporting the utilization of procalcitonin in children in a variety of clinical scenarios including SIRS, sepsis, burns, and trauma and to identify existing knowledge gaps. Methods. A thorough review of the literature was performed utilizing PubMed. We focused on using meta-analysis from adult populations to review current practices in interpretation and methodology and find concordant pediatric studies to determine if the same applications are validated in pediatric populations. Results. Current evidence supports the usage of procalcitonin as both a sensitive and a specific marker for the differentiation of systemic inflammatory response syndrome from sepsis in pediatrics with increased diagnostic accuracy compared to commonly used biomarkers including complete blood counts and C-reactive protein. Conclusions. Although the body of evidence is limited, initial observations suggest that procalcitonin can be used in pediatric trauma and burn patients as both a prognostic and a diagnostic marker, aiding in the identification of infection in patients with extensive underlying inflammation.

Impaired sphingolipid synthesis in the respiratory tract induces airway hyperreactivity.

Asthma is a clinically heterogeneous genetic disease, and its pathogenesis is incompletely understood. Genome-wide association studies link ORM (yeast)-Like protein isoform 3 [corrected] (ORMDL3), a member of the ORM gene family, to nonallergic childhood-onset asthma. Orm proteins negatively regulate sphingolipid (SL) synthesis by acting as homeostatic regulators of serine palmitoyl-CoA transferase (SPT), the rate-limiting enzyme of de novo SL synthesis, but it is not known how SPT activity or SL synthesis is related to asthma. The present study analyzes the effect of decreased de novo SL synthesis in the lung on airway reactivity after administration of myriocin, an inhibitor of SPT, and in SPT heterozygous knockout mice. We show that, in both models, decreased de novo SL synthesis increases bronchial reactivity in the absence of inflammation. Decreased SPT activity affected intracellular magnesium homeostasis and altered the bronchial sensitivity to magnesium. This functionally links decreased de novo SL synthesis to asthma and so identifies this metabolic pathway as a potential target for therapeutic interventions.

Effect of prolonged discontinuation of L-thyroxine replacement in a child with congenital hypothyroidism.

When diagnosed through neonatal screening and treated promptly and adequately, infants with congenital hypothyroidism (CH) experience normal physical growth and neurological development. Here we present a 3-year-old boy diagnosed with CH as a newborn, who was subsequently left untreated and experienced significant growth failure and developmental delay. This case emphasizes the importance of a consistent adherence to treatment in preventing such complications, especially in infancy and early childhood.