Analytical description of adolescent binge drinking patients.

BACKGROUND: Binge drinking is a widespread health compromising behavior among adolescents and young adults, leading to significant health problems, injuries and mortality. However, data on alcohol consumption is often unreliable, as it is mainly based on self-reporting surveys. In this five-year study (2014-2019) at the University Children's Hospital Zurich, we analyzed blood samples from adolescent binge drinking patients to investigate blood alcohol concentrations (BACs), co-ingestion of drugs, assess compliance between self-reported and measured substance use, and test for genetic components of innate alcohol tolerance. Furthermore, hair analysis was performed to retrospectively access drug exposure and to evaluate the potential of hair analysis to assess binge drinking. METHODS: In a prospective, single-center study, patients with alcohol intoxications aged 16 years and younger were included. Blood and hair samples were analyzed by sensitive liquid chromatography - tandem mass spectrometry drug analysis. HTTLPR genotyping was performed with PCR and fragment analysis. RESULTS: Among 72 cases, 72 blood and 13 hair samples were analyzed. BACs ranged from 0.08-3.20‰ (mean 1.63‰, median 1.60‰), while a mean concentration of 3.64 pg/mg hair (median 3.0 pg/mg) of the alcohol marker ethyl glucuronide (EtG) was detected in eleven hair samples, providing no evidence of chronic excessive drinking. In 47% of the cases, co-ingested drugs were qualitatively detected next to ethanol, but only 9% of the detected drugs had blood concentrations classified as pharmacologically active. Cannabis consumption (22%) and stimulant intake (16%) were the most frequently observed drugs. Compliance between patients' statements and measured substances matched well. Although we investigated the genetic contribution to innate alcohol tolerance via the 5-HTTLPR polymorphism, the diverse genetic background of the cohort and small sample size did not allow any conclusions to be drawn. CONCLUSION: Almost half of our binge drinking patients tested positive for other substances, primarily cannabis. We anticipate that our study enhances understanding of consumption behavior of young people and encourage continued efforts to address the harmful effects of binge drinking and co-occurring substance use.

A 3-year Retrospective Analysis of Dento-Alveolar Injuries at the University Children's Hospital Zurich (2018-2020).

Children and adolescents are vulnerable to dental trauma due to their active lifestyles, lack of coordination, and inexperience in recognizing potentially dangerous situations. Early recognition and proper management of dental trauma is crucial in order to minimize the risk of complications and ensure optimal outcomes. The aim of this study was to perform a retrospective analysis of all dento-alveolar injuries in children and adolescents who were treated at the University Children's Hospital Zurich from 2018-2020 by the resident physicians of the Centre of Dental Medicine of the University of Zurich. All information concerning age and sex distribution, seasonal and weekly variations, as well as aetiology, types of trauma and co-affected structures in the head and neck area from 389 patients was analysed. For data extraction, a parameterised Excel list was created, enabling a continuous data collection. In the study, 65% of the patients were male and 35% female. The average patient age was 7 years and 4 months. The highest frequency of trauma occurred in mixed dentition (49%), followed by deciduous dentition (36%) and permanent dentition (15%). Most of the accidents occurred in the second quarter of the year, especially in the month of May slightly more injuries were reported. The most common injuries were increased tooth mobility (40%) and tooth fractures without pulp exposure (34%). Less frequent were tooth fractures with pulp exposure (12%), lateral dislocations (29%), avulsions (21%), intrusions (8%), extrusions (6%) and root fractures (4%). As in many studies the upper central incisors were most often affected. Main causes of dental trauma were falls, especially by bike (18%) or scooter (14%). Soft tissue injuries or fractures, in the area of the head and neck occurred in 59% and 10% of the cases simultaneously accompanied by dento-alveolar trauma.

Consensus Minimal Dataset for Pediatric Emergency Medicine in Switzerland.

OBJECTIVES: Standardized, harmonized data sets generated through routine clinical and administrative documentation can greatly accelerate the generation of evidence to improve patient care. The objective of this study was to define a pediatric emergency medicine (PEM) minimal dataset for Switzerland (Swiss PEM minimal dataset) and to contribute a subspecialty module to a national pediatric data harmonization process (SwissPedData). METHODS: We completed a modified Delphi survey, inviting experts from all major Swiss pediatric emergency departments (PEDs). RESULTS: Twelve experts from 10 Swiss PEDs, through 3 Delphi survey rounds and a moderated e-mail discussion, suggested a subspecialty module for PEM to complement the newly developed SwissPedData main common data model (CDM). The PEM subspecialty CDM contains 28 common data elements (CDEs) specific to PEM. Additional CDEs cover PEM-specific admission processes (type of arrival), timestamps (time of death), greater details on investigations and treatments received at the PED, and PEM procedures (eg, procedural sedation). In addition to the 28 CDEs specific to PEM, 43 items from the SwissPedData main CDM were selected to create a Swiss PEM minimal dataset. The final Swiss PEM minimal dataset was similar in scope and content to the registry of the Pediatric Emergency Care Applied Research Network. CONCLUSIONS: A practical minimal dataset for PEM in Switzerland was developed through recognized consensus methodology. The Swiss PEM minimal dataset developed by Swiss PEM experts will facilitate international data sharing for PEM research and quality improvement projects.

A tale of two parts of Switzerland: regional differences in the impact of the COVID-19 pandemic on parents.

BACKGROUND: We aimed to document the impact of the coronavirus disease 2019 (COVID-19) pandemic on regions within a European country. METHODS: Parents arriving at two pediatric emergency departments (EDs) in North of Switzerland and two in South of Switzerland completed an online survey during the first peak of the pandemic (April-June 2020). They were asked to rate their concern about their children or themselves having COVID-19. RESULTS: A total of 662 respondents completed the survey. Parents in the South were significantly more exposed to someone tested positive for COVID-19 than in the North (13.9 and 4.7%, respectively; P <  0.001). Parents in the South were much more concerned than in the North that they (mean 4.61 and 3.32, respectively; P <  0.001) or their child (mean 4.79 and 3.17, respectively; P <  0.001) had COVID-19. Parents reported their children wore facemasks significantly more often in the South than in the North (71.5 and 23.5%, respectively; P <  0.001). CONCLUSION: The COVID-19 pandemic resulted in significant regional differences among families arriving at EDs in Switzerland. Public health agencies should consider regional strategies, rather than country-wide guidelines, in future pandemics and for vaccination against COVID-19 for children.

Parents' intent to vaccinate against influenza during the COVID-19 pandemic in two regions in Switzerland.

AIMS OF THE STUDY: The COVID-19 pandemic is likely to overlap with the seasonal influenza epidemic, increasing the risk of overextending the health system capacity in Switzerland. Influenza vaccine uptake has remained low in most countries, including Switzerland. The aim of the study was to determine parents’ intentions towards influenza vaccination of their children, as well as themselves, and to assess regional differences. METHODS: Parents presenting to four paediatric emergency departments (Zurich, Bern, Bellinzona, Geneva) were asked to complete an online survey during and after the first lockdown of the COVID-19 pandemic (April to June 2020). The anonymised survey included demographic information, vaccination history and intentions to vaccinate against influenza, as well as attitudes towards future vaccination against COVID-19. RESULTS: The majority of children (92%; 602/654) were up-to-date on their vaccination schedule. In 2019/2020, 7.2% (47/654) were vaccinated against influenza. Children with chronic illnesses were more frequently vaccinated than healthy children (19.2% vs 5.6%; p = 0.002). For the coming winter season, 111 (17%) parents stated they plan to vaccinate their children against influenza, more than double the rate from last year, and 383 (59.2%) parents suggested they will vaccinate against COVID-19 once a vaccine is available. Regional differences between “German” and “Latin” Switzerland were found for parents’ intent to have their children vaccinated against influenza next season (Zurich and Bern 14.3%, Bellinzona and Geneva 27.2%, p <0.001), but not for a hypothetical vaccination against COVID-19 (Zurich and Bern 59.1%, Bellinzona and Geneva 59.7%, p = 0.894). CONCLUSIONS: The COVID-19 pandemic resulted in a substantial increase of parents’ intention to vaccinate their children against influenza, especially in hard-hit “Latin” Switzerland. The Swiss government and public health organisations can leverage these regional results to promote influenza vaccination among children for the coming seasons.

Unplanned Return Visits to a Pediatric Emergency Department.

OBJECTIVES: Unplanned return visits (URVs) to emergency departments (EDs) account internationally for 2.5% to 5.2% of all consultations. ED crowding is an increasing challenge, and URVs seem to contribute to this problem. This study aimed to assess factors for URVs at the ED of a tertiary children's hospital to analyze if they are jointly responsible for the steadily rising amount of treated patients. METHODS: All patients with an URV to a pediatric ED in Switzerland between January and December 2013 were included in the study. Data were taken retrospectively from the electronic patient files, and different variables were defined and analyzed. RESULTS: URVs occurred at an incidence of 4.6%, and mostly concerned infants and toddlers (46%). URVs were independent of weekdays and mostly occurred between 10 am and 10 pm. In 84.2% of the cases, the URVs were judged as unnecessary, and in 15.8%, a hospitalization was indicated, mainly for children with a worsening respiratory illness. CONCLUSIONS: The occurrence of URVs in our ED was within the incidence reported in the literature. While URVs lead to hospitalization in some patients, the majority of URVs were unnecessary from a medical point of view. These results indicate that a correct evaluation of the child's health state by parents is often challenging and requires repeated medical attendance following a first ED visit, especially in infants with airway diseases and infections. Intensive counseling and scheduled short-term follow-up consultation at the pediatrician's office could prevent URVs to the ED.

Short and long-arm fiberglass cast immobilization for displaced distal forearm fractures in children: a randomized controlled trial.

PURPOSE: The aim of this study was to investigate whether short-arm fiberglass cast (SAC) immobilization provides fracture stabilization comparable to that of long-arm cast (LAC) treatment of displaced distal forearm fractures after closed reduction in paediatric patients. METHODS: A prospective, randomized, controlled trial of children aged four to 16 years (mean 9.9 years) was designed with a sample of 120 children, whose size was set a priori, with 60 treated with SAC and 60 with LAC. The primary outcome was fracture stability and rate of loss of reduction. The secondary outcome analysis evaluated duration of analgesic therapy, restriction in activities of daily life, and the duration until patients regained normal range of motion in the elbow. RESULTS: No statistically significant differences were found between the two groups in loss of reduction or duration of analgesic therapy. In contrast, the duration until normal range of motion in the elbow was regained was significantly longer in the LAC group (median 4.5 days, P < 0.001). Restriction in activities of daily life did not differ significantly between the two groups except for the item "help needed with showering in the first days after trauma" (SAC 60%, LAC 87%, P = 0.001). CONCLUSION: Fracture immobilization with short-arm fiberglass cast in reduced distal forearm fractures is not inferior to long-arm casts in children four years and older, excluding completely displaced fractures. Furthermore, short-arm casting reduces the need for assistance during showering. TRIAL REGISTRATION: NCT03297047, September 29, 2017.

Parents' intent to vaccinate against influenza during the COVID-19 pandemic im two regions in Switzerland.

AIMS OF THE STUDY: The COVID-19 pandemic is likely to overlap with the seasonal influenza epidemic, increasing the risk of overextending the health system capacity in Switzerland. Influenza vaccine uptake has remained low in most countries, including Switzerland. The aim of the study was to determine parents' intentions towards influenza vaccination of their children as well as themselves, and to assess regional differences. METHODS: Parents presenting to four pediatric emergency departments (PEDs; Zurich, Bern, Bellinzona, Geneva) were asked to complete an online survey during and after the first lockdown of the COVID-19 pandemic (April - June 2020). The anonymized survey included demographic information, vaccination history and intentions to vaccinate against influenza, as well as attitudes towards future vaccination against COVID-19. RESULTS: The majority of children (92%; 602/654) were up-to-date on their vaccination schedule. In 2019/2020, 7.2% (47/654) were vaccinated against influenza. Children with chronic illnesses were more frequently vaccinated compared to healthy children (19.2% vs 5.6%; p = 0.002). For the coming winter season, 111 (17%) parents stated they plan to vaccinate their children against influenza, more than double the rate from last year, and 383 (59.2%) parents suggest they will vaccinate against COVID-19 once a vaccine is available. Regional differences between "German" and "Latin" Switzerland were found for parents' intent to have their children vaccinated against influenza next season (Zurich and Bern 14.3%, Bellinzona and Geneva 27.2%, p < 0.001) but not for a hypothetical vaccination against COVID-19 (Zurich and Bern 59.1%, Bellinzona and Geneva 59.7%, p = 0.894). CONCLUSIONS: The COVID-19 pandemic resulted in a substantial increase of parents' intention to vaccinating their children against influenza, especially in hard-hit "Latin" Switzerland. The Swiss government and public health organizations can leverage these regional results to promote influenza vaccination among children for the coming seasons.

Factors associated with parents' willingness to enroll their children in trials for COVID-19 vaccination.

The coronavirus disease 2019 (COVID-19) pandemic has taken an unprecedented global toll and vaccination is needed to restore healthy living. Timely inclusion of children in vaccination trials is critical. We surveyed caregivers of children seeking care in 17 Emergency Departments (ED) across 6 countries during the peak of the pandemic to identify factors associated with intent to participate in COVID-19 vaccine trials. Questions about child and parent characteristics, COVID-19 expressed concerns and parental attitudes toward participation in a trial were asked.Of 2768 completed surveys, 18.4% parents stated they would enroll their child in a clinical trial for a COVID-19 vaccine and 14.4% would agree to a randomized placebo-controlled study. Factors associated with willingness to participate were parents agreeing to enroll in a COVID-19 vaccine trial themselves (Odds Ratio (OR) 32.9, 95% Confidence Interval (CI) (21.9-51.2)) having an older child (OR 1.0 (1.0-1.01)), having children who received all vaccinations based on their country schedule (OR 2.67 (1.35-5.71)) and parents with high school education or lower (OR 1.79 (1.18-2.74)). Mothers were less likely to enroll their child in a trial (OR 0.68 (0.47-0.97)). Only one fifth of families surveyed will consider enrolling their child in a vaccine trial. Parental interest in participation, history of vaccinating their child, and the child being older all are associated with parents allowing their child to participate in a COVID vaccine trial. This information may help decision-makers and researchers shape their strategies for trial design and participation engagement in upcoming COVID19 vaccination trials.

Caregiver willingness to vaccinate their children against COVID-19: Cross sectional survey.

BACKGROUND: More than 100 COVID-19 vaccine candidates are in development since the SARS-CoV-2 genetic sequence was published in January 2020. The uptake of a COVID-19 vaccine among children will be instrumental in limiting the spread of the disease as herd immunity may require vaccine coverage of up to 80% of the population. Prior history of pandemic vaccine coverage was as low as 40% among children in the United States during the 2009 H1N1 influenza pandemic. PURPOSE: To investigate predictors associated with global caregivers' intent to vaccinate their children against COVID-19, when the vaccine becomes available. METHOD: An international cross sectional survey of 1541 caregivers arriving with their children to 16 pediatric Emergency Departments (ED) across six countries from March 26 to May 31, 2020. RESULTS: 65% (n = 1005) of caregivers reported that they intend to vaccinate their child against COVID-19, once a vaccine is available. A univariate and subsequent multivariate analysis found that increased intended uptake was associated with children that were older, children with no chronic illness, when fathers completed the survey, children up-to-date on their vaccination schedule, recent history of vaccination against influenza, and caregivers concerned their child had COVID-19 at the time of survey completion in the ED. The most common reason reported by caregivers intending to vaccinate was to protect their child (62%), and the most common reason reported by caregivers refusing vaccination was the vaccine's novelty (52%). CONCLUSIONS: The majority of caregivers intend to vaccinate their children against COVID-19, though uptake will likely be associated with specific factors such as child and caregiver demographics and vaccination history. Public health strategies need to address barriers to uptake by providing evidence about an upcoming COVID-19 vaccine's safety and efficacy, highlighting the risks and consequences of infection in children, and educating caregivers on the role of vaccination.

A Prospective Controlled Study on Long-Term Outcomes of Facial Lacerations in Children.

Background: Although skin adhesives have been used for decades to treat skin lacerations, uncertainty remains about long-term results, and complications. Methods: In this prospective, controlled, single-blinded, observational cohort study, outcomes were assessed by five plastic surgeons with standardized photographs at 6-12 months using a modified Patient and Observer Scar Assessment Scale (POSAS) and Vancouver Scar Scale (VSS); additionally, the POSAS was performed by the patients/caregivers and the physician; pain, requirement of anesthesia, treatment time, costs, complications, and quality of live (QoL) were assessed. Results: A total of 367 patients were enrolled; 230 were included in the main analysis; 96 wounds were closed using tissue adhesives (group 1); 134 were sutured (group 2). Assessment by the independent observers revealed an improved mean modified overall POSAS score in group 1 in comparison with group 2 [2.1, 95% CI [1.97-2.25] vs. 2.5, 95% CI [2.39-2.63]; p < 0.001, d = 0.58] and mean VSS score [1.2, 95% CI [0.981-1.34] vs. 1.6, 95% CI [1.49-1.79], p < 0.001, d = 0.53]. At the early follow-up, dehiscence rate was 12.5% in group 1 and 3.7% in group 2 (p < 0.001); later on, one dehiscence remained per group. Mild impairment of QoL was found at the early follow-up in both groups, with no impairment remaining later on. Duration of treatment and treatment costs were lower in group 1. Conclusion: Both modalities of wound closure yield favorable esthetic results, and complications are rare. Adhesives are more cost-effective, and its application is less time-consuming; therefore, tissue adhesives offer considerable advantages when used appropriately. Trial Registration: Public trial registration was performed at www.ClinicalTrials.gov (Identifier: NCT03080467).

Video Recordings to Analyze Preventable Management Errors in Pediatric Resuscitation Bay.

OBJECTIVE: In treating patients of different ages and diseases in the pediatric resuscitation bay, management errors are common. This study aimed to analyze the adherence to advanced trauma life support and pediatric advanced life support guidelines and identify management errors in the pediatric resuscitation bay by using video recordings. METHODS: Video recording of all patients admitted to the pediatric resuscitation bay at University Children's Hospital Zurich during a 13-month period was performed. Treatment adherence to advanced trauma life support guidelines and pediatric advanced life support guidelines and errors per patient were identified. RESULTS: During the study period, 128 patients were recorded (65.6% with surgical, 34.4% with medical diseases). The most common causes for admission were traumatic brain injury (21.1%), multiple trauma (20.3%), and seizures (14.8%). There was a statistically significant correlation between accurate handover from emergency medical service to hospital physicians and adherence to airway, breathing, circulation, and disability sequence (correlation coefficient [CC], 0.205; P = 0.021), existence of a defined team leader and adherence to airway, breathing, circulation, and disability sequence (CC, 0.856; P < 0.001), and accurate hand over and existence of a defined team leader (CC, 0.186; P = 0.037). Unexpected errors were revealed. Cervical spine examination/stabilization was omitted in 40% of admitted surgical patients, even in 20% of patients with an injury of spine/limbs. CONCLUSIONS: Video recording is a useful tool to evaluate patient management in the pediatric resuscitation bay. Analyzing errors of missing the adherence to the guidelines helps to pay attention and focus on specific items to improve patient care.

Ketamine procedural analgosedation before and after introducing nitrous oxide 70% in a paediatric emergency department.

AIMS OF THE STUDY: The spectrum of agents available for procedural analgosedation (PAS) in paediatric emergency departments (EDs) has increased over the last few decades, yet the pharmacological agents most used in our ED are ketamine and nitrous oxide (N2O). The aim of this study was to assess which patient characteristics in an ambulatory setting were associated with physicians selecting N2O 70% or ketamine as the sedating agent in our paediatric ED, after N2O 70% was introduced. METHODS: Patients aged 0 to 16 years who received PAS in a tertiary children’s hospital ED in 2007 (before N2O 70% implementation) and 2016 (after N2O implementation) were included in this retrospective, single-centre cohort study. Data were collected by querying the outpatient ED database for N2O 70% and ketamine. Obtained data included patient characteristics, procedure type and sedation medication. RESULTS: 1168 patients were included; 59.8% (699) were male. The overall mean age was 6.3 (± 4.0) years; in the ketamine subgroup, 4.6 (± 4.0) years and in the N2O subgroup, 7.8 (± 3.4) years. In 2016, N2O was chosen in 86.7% of cases involving children aged 4 to 16 years, compared to 28.5% of cases involving children three years and younger. The most apparent shift from ketamine to N2O occurred in patients with displaced upper extremity fractures, with an increase of N2O 70% from 0% in 2007 to 90.8% in 2016. CONCLUSIONS: The use of ketamine PAS shifted to N2O PAS, especially in children older than three years and for the reduction of displaced upper extremity fractures.

Correction to: Compartment pressures in children with normal and fractured lower extremities.

The original version of this article unfortunately contained a mistake in the author name Sasha Job Tharakan. The corrected name is given above.

Compartment pressures in children with normal and fractured lower extremities.

PURPOSE: Needle manometry is a tool to confirm suspected acute compartment syndrome (ACS). There is scarce evidence of normal pressure values of the lower extremities in children. The aim of this study is to assess the normal compartment pressures in non-injured lower extremities of children. METHODS: This prospective study included children up to the age of 16 years with lower extremity fractures that needed reduction. Between June 2009 and August 2015, 20 children were included. We used needle manometry to measure the pressures in the superficial (SPC), deep posterior (DPC) and in the anterior compartments (AC) on both the lower legs. RESULTS: On the healthy leg, the mean compartment pressure was 15.15 mmHg in the AC (range 7-30 mmHg), 14.32 mmHg in the SPC (range 8-24 mmHg) and 13.00 mmHg in the DPC (range 4-21 mmHg). On the injured leg, the mean compartment pressure was 24.07 mmHg in the AC (range 5-40 mmHg), 17.21 mmHg in the SPC (range 7-29 mmHg) and 17.13 mmHg in the DPC (range 6-37 mmHg). We found a perfusion gradient (diastolic blood pressure-compartment pressure) < 30 mmHg in at least one compartment of the fractured and healthy leg in 13 patients. Five patients underwent fasciotomy for suspected ACS and their data was excluded for the injured leg. CONCLUSION: We could show that children have higher normal compartment pressures than adults in the lower leg. They seem to be able to tolerate higher absolute compartment pressures and lower pressure gradients before ACS occurs. More studies are needed to make a final statement on tolerable compartment pressures in children.

Combined nitrous oxide 70% with intranasal fentanyl for procedural analgosedation in children: a prospective, randomised, double-blind, placebo-controlled trial.

OBJECTIVE: Nitrous oxide 70% (N2O 70%) is an excellent medication for procedural analgosedation (PAS), yet the limit of its analgesic power remains uncertain; therefore, a combination with intranasal fentanyl (INF) was suggested. However, this combination seems to result in a higher rate of vomiting and deeper sedation. This study aimed at assessing the analgesic efficacy, sedation depth and rate of adverse events of PAS with N2O 70% with and without INF. METHODS: Patients aged 2-16 years who qualified for PAS with N2O 70% were randomly assigned to receive either INF or placebo prior to N2O inhalation in this randomised, double-blind study, which was performed in a tertiary children's hospital ED between September 2015 and October 2017. Behaviour during the procedure was evaluated using the Face, Leg, Activity, Cry and Consolability (FLACC) scale and the Modified Behavioural Pain Scale (MBPS); analgesic efficacy was assessed with a self-reported pain scale. Sedation depth using the validated University of Michigan Sedation Scale and adverse events in the ED and during the following 12 hours were documented. RESULTS: A total of 402 patients were included; 3 did not tolerate N2O and therefore had to be excluded. Overall, 399 patients were analysed, of whom 201 (50.4%) received INF. No significant group differences with regard to FLACC scale score, self-reported pain, MBPS score and sedation depth were found. In addition, the two groups did not differ with regard to all types of adverse events. CONCLUSION: Combining N2O 70% with INF resulted in no differences with regard to FLACC scale score, self-reported pain, MBPS score, patient and parental satisfaction rate, sedation depth, and adverse events. TRIAL REGISTRATION NUMBER: NCT02533908.

Nitrous Oxide 70% for Procedural Analgosedation in a Pediatric Emergency Department-With or Without Intranasal Fentanyl?

OBJECTIVES: Nitrous oxide 70% (N20 70%) is an excellent medication for procedural analgosedation in a pediatric emergency department. However, its analgesic efficacy remains uncertain for painful procedures; therefore, a combination with intranasal fentanyl (INF), an opioid, was suggested. This study aimed at observing and assessing the analgesic efficacy and rate of adverse events using N20 70% with and without INF. METHODS: Children who received N20 70% in a tertiary children's hospital emergency department from January 1, 2014 to June 30, 2015 were included in this observational study with prospective data collection. Physicians decided individually whether INF was administered. Medical staff documented the child's behavior during the procedure, adverse events, and satisfaction rate. RESULTS: A total of 442 children were included; 206 (46.6%) received INF. Group differences regarding patient behavior were not statistically significant; however, N20 70% application time was longer in the INF group (P = .02). Nausea was the most frequent adverse event with 13.1% in the INF group versus 8.1% without INF. Inadequate procedural analgosedation was documented only in the INF group, affecting 1.8% of all patients (P = .002). In contrast, anxiety was exclusively observed in the group without INF, which was presumably misjudged pain (P = .03); the satisfaction rate in the INF group was 95.6% compared with 98.7% without INF. CONCLUSIONS: Because of the study design and limitations, no conclusions about adding INF to N20 70% can be made. Additional research is needed to investigate the effect of combining N20 70% with INF.

Tongue lacerations in children: to suture or not?

AIMS OF THE STUDY: Tongue lacerations are common in children, occurring mostly from falls or sports injuries. Optimal treatment of tongue lacerations is a challenge for paediatricians due to contradictory recommendations and a lack of current guidelines. It remains unclear which tongue lacerations should be sutured and which would benefit from spontaneous healing, which is a promising alternative. In recent years, the treatment of choice in our paediatric emergency department (ED) has shifted from generally suturing the wounds to more frequently advising secondary wound healing. The aim of this study was to analyse tongue lacerations treated at our ED in order to develop guidance for the optimal management of tongue lacerations in children. METHODS: This retrospective study was conducted to assess tongue lacerations at the ED of a University Children's Hospital Zurich from January 2010 to August 2015. All families were contacted for informed consent and photo documentation of the healed tongue. Clinical records of all the patients included were reviewed and different variables were defined and analysed. RESULTS: A total of 73 children with tongue lacerations were included (75.3% boys, mean age ± standard deviation 4.0 ± 2.6 years). The mean size of the lacerations was 12.4 ± 8.3 mm, with affected tongue borders in 51 cases (69.9%) and a through-and-through laceration in 23 patients (31.5%). A primary wound closure was performed in 12 children (16.4%). These wounds were significantly larger than those of the secondary wound healing group (21 ± 10 mm compared to 10.8 ± 6.8 mm), presented gaping wound edges with the tongue at rest more frequently (91.7% compared to 32.8%), and showed through-and-through lacerations more often (91.7% compared to 19.7%). The group with wound suturing needed longer to recover (median 13 days compared to 6.2 days) and had a higher rate of complications (25 vs 3.3%). CONCLUSIONS: Suturing is not required in gaping tongue lacerations less than 2 cm long that do not involve the tip of the tongue. The Zurich Tongue Scheme was developed as a guide for clinicians when deciding which tongue lacerations need suturing.