ATV-Related Trauma in the Pediatric Population.

BACKGROUND: All-terrain vehicles (ATVs) are prevalent in Appalachia and cause significant morbidity and mortality in the pediatric population. This study investigated the injury types and severity in pediatric patients over a 15-year period. METHODS: A retrospective chart review was performed on pediatric ATV-related traumas presenting to our institution from 2005 to 2020. Patients were divided into 3 age groups (0-7, 8-12, and 13-17 y) to evaluate differences in accident demographics, hospitalization, Glasgow Coma Scale, Injury Severity Score, substance use, characterization of orthopaedic and nonorthopaedic injuries, and procedures performed. RESULTS: Inclusion criteria were met by 802 patients. Males represented 71.7% (n=575) and females 28.3% (n=227); the mean age was 12.4 years. The majority (88.5%, n=710) of patients admitted following their accident had a mean stay length of 3.3 days. Of admissions, intensive care unit admission was required by 23.8%, n=191 (mean stay 4.0 d). There were 7 fatalities. The vast majority of accidents occurred between May and September (79.2%, n=635). In patients with documented helmet status, 45% (n=271) were helmeted. Roughly half of all patients (n=393) sustained a fracture (excluding fractures to the head), 370 sustained an injury to the head/face, 129 sustained intra-abdominal/intra-thoracic injuries, and 29 sustained injuries to all 3 systems. The most common fractures involved the forearm (n=98), femur (n=65), and spine (n=59). The most common open fractures were the tibia (n=12), humerus (n=8), and forearm (n=8). The oldest group was more likely than the middle or younger groups to sustain spine ( P <0.0001), pelvis ( P =0.0001), hand ( P =0.0089), and foot ( P =0.0487) fractures. Ethanol testing was positive in 5.0% (n=25) of the oldest group and cannabinoids were present in 6.8% (n=34). The youngest group was significantly more likely to sustain a fracture of the humerus than the middle or older groups ( P <0.0001). Orthopaedic surgical management was required in 24.4% (n=196) of patients. CONCLUSIONS: Pediatric ATV accidents present a significant source of morbidity and mortality. Further intervention is necessary to minimize pediatric ATV injuries. LEVEL OF EVIDENCE: Level IV-Retrospective Case Series.

The impact of epidural analgesia for acute pancreatitis on maternal and fetal outcome: a cohort study.

It is anticipated that between 1 in 10, 000 and 1 in 30, 000 pregnancies will be affected by acute pancreatitis (AP). The authors wanted to evaluate the impact of epidural analgesia on maternal and fetal outcomes and its effectiveness in the pain treatment of obstetric patients with AP. Methodology: The period for this cohort research was from January 2022 to September 2022. Fifty pregnant women with AP symptoms were enrolled in the study. Conservative medical management was done using intravenous (i.v.) analgesics, including fentanyl and tramadol. Fentanyl was infused i.v. at a rate of 1 µg/kg every hour, while tramadol was bolused i.v. at 100 mg/kg every 8 h. Boluses of 10-15 ml of 0.1% ropivacaine were injected into the L1-L2 interspace at 2-3-h intervals to provide high lumbar epidural analgesia. Results: In this study, 10 patients were given an i.v. infusion of fentanyl, and 20 patients were given tramadol boluses. Epidural analgesia showed the most promising results decreasing the visual analog scale score from 9 to 2 in half of the patients. Most fetal complications were noticed in the tramadol group, including prematurity, respiratory distress, and babies requiring noninvasive ventilation. Conclusion: Patients with AP during pregnancy may benefit from a new technique for simultaneous analgesia during labor and cesarean section administered via a single catheter. When AP is detected and treated during pregnancy, the mother and child benefit from pain control and recovery.

Retraction: Comparison of Outcomes of Percutaneous Nephrolithotomy (PCNL) Between Adults and Pediatrics Population: A Single-Center Retrospective Study.

[This retracts the article DOI: 10.7759/cureus.22690.].

Comparison of Outcomes of Percutaneous Nephrolithotomy (PCNL) Between Adults and Pediatrics Population: A Single-Center Retrospective Study.

INTRODUCTION: Percutaneous nephrolithotomy (PCNL) has almost completely replaced open surgery for kidney stones because of continuous advancements in the method since the first PCNL was performed in 1976. The aim of this study is to compare the characteristics and outcomes of adult patients and pediatric patients who had undergone PCNL. METHODOLOGY: A retrospective study was conducted at the Sindh Institute of Urology and Transplantation (SIUT) Hospital in Karachi, Pakistan. It included the data of patients who underwent PCNL from January 2015 to January 2022 at the SIUT hospital. The primary outcome variable was the stone-free rate (SFR). Secondary outcomes included length of hospital stay, and complications were assessed using modified Clavien classification system Results: There is no significant difference in the SFR at discharge between pediatric and adult patients (86.67% vs 88.69%, p=0.634). There is no significant difference between the two groups in relation to the total length of hospital stay (p=0.446). Moreover, 12.50% and 11.11% of adults and children developed complications, respectively, after the procedure. The percentages are not significantly different between the two groups (p=0.266). CONCLUSION: The current study using standardized and consistent PCNL techniques shows that SFR is similar in both adults and children, and there is no difference in complications between adults and children.