Variation in utilization of computed tomography scanning for the investigation of minor head trauma in children: a Canadian experience.

OBJECTIVES: To compare the utilization rates of CT scans in investigating minor head trauma in children in Canada, to identify the injuries determined by these scans, and to identify clinical findings that are highly associated with its diagnosis and the injury itself. METHODS: A retrospective cohort study involving nine pediatric hospitals in Canada was conducted. A structured data collection method was used. Inclusion criteria included age 16 years or less, history of blunt head trauma, and a Glasgow Coma Scale score (GCS) greater than or equal to 13. Data collected included demographic information, type of injury, relevant clinical information, computed tomography (CT) scan data, and clinical outcome. Clinical findings associated with CT scan and positive CT scan were identified using logistic regression. RESULTS: One thousand one hundred sixty-four children were included in the study. One hundred seventy-one (15%) had a CT scan, of which 60 (35%) were abnormal. There was a significant difference in the rate of ordering of CT scans among the participating hospitals, but no significant difference in the rate of abnormal CT scans. Mechanism of injury, GCS, and loss of consciousness were significantly related to the presence of an abnormal CT scan. CONCLUSIONS: Although there is a significant difference in the utilization of CT scans to investigate minor head trauma in children across Canada, there is no significant difference in the frequency of head injuries in these patients. This suggests that it may be possible to determine clinical criteria that are predictive of a head injury in these patients.

Puncture wounds.

Puncture wounds are common in children, and most are uncomplicated. For children who have a delayed presentation or signs of infection, consider the possibility of a retained foreign body. The diagnosis of P aeruginosa osteochondritis should be considered in any child who exhibits persistent signs and symptoms after puncture wounds; timely use of laboratory tests, radiologic imaging, and orthopedic referral is required.

Case-control study of primary human herpesvirus 6 infection in children with febrile seizures.

RATIONALE: Human herpesvirus 6 (HHV-6) has been demonstrated to be the causative agent in roseola infantum. It has been suggested that HHV-6 may have neurotropic properties and be involved in the pathogenesis of febrile seizures in infants. We describe a case-control study to examine the hypothesis that acute HHV-6 infection occurs more commonly in children with febrile seizures than in controls. METHODS: Patients presenting with a first or second febrile seizure between 6 months and 2 years of age were entered in the study. Control patients did not have a seizure but had similar inclusion and exclusion criteria. Specimens were obtained for HHV-6 viral serology and polymerase chain reaction in the acute stage and approximately 2 weeks later. A diagnosis of HHV-6 infection was based on HHV-6-specific IgM and IgG serology and HHV-6 polymerase chain reaction of peripheral blood mononuclear cells and saliva. RESULTS: Eighty-six patients (45 with febrile seizures; 41 controls) were enrolled. The HHV-6 infection status could be determined in only 68 patients (35 with febrile seizures; 33 controls). Acute HHV-6 infection was identified in 15 of 35 febrile seizure patients and in 15 of 33 controls. Evidence of past HHV-6 infection was demonstrated in 13 febrile seizure patients and in 8 controls. CONCLUSIONS: The incidence of primary HHV-6 infection is similar in patients with febrile seizures and age-matched controls. HHV-6 does not seem to be a major factor in the pathogenesis of first and second febrile seizures.

HBV markers in Chinese in Hong Kong.

A study was carried out on 779 hospital patients in the Orthopaedic and Paediatric Unit of Queen Mary Hospital, Hong Kong. Patients who had no clinical evidence of liver disease, previous history of transfusion with blood or blood products and no major surgery in the past were entered into the study. Markers of previous exposure to Hepatitis B virus (HBV) were HBsAg, anti-HBc and anti-HBs (radioimmunoassay) were done. The results showed that (a) Chinese living in Hong Kong are exposed to HBV infection throughout life (b) horizontal transmission is the dominant mode of transmission and (c) cpronic HBsAg carriers probably do not carry HBV for life but may clear HBs antigenaemia with age.

Bronchial cancer in Hong Kong, 1976-77: a preliminary report.

A case-control study of the relationship of bronchial cancer to smoking was conducted during 1976-77 in Hong Kong, in which we took particular note of the histologic type of the tumor. A total of 132 male and 111 female patients were interviewed. The association with smoking was more evident in males than it was in females, and squamous and small-cell type carcinomas, as a group, appeared to be more closely associated with smoking than did adenocarcinomas and large cell tumors. Of the women with bronchial carcinoma, 44% were nonsmokers; 79% of their tumors were adenocarcinomas or large cell carcinomas. For the women in this group, no association could be detected with place of residence, occupation, or use of kerosene for cooking.

Bronchial cancer in Hong Kong 1976-1977.

Bronchial cancer is a disease of high and increasing annual incidence in Hong Kong, especially in women, whose age-specific death rates from this cause are amongst the highest in the world. A case-control study of the relationship of bronchial cancer with smoking was carried out during 1976--77, taking particular note of the histological type of the tumour. Two hundred and eight male and 189 female patients were interviewed, covering about half the total number of cases of bronchial cancer registered as dead from the disease in Hong Kong during the period of the survey. The association with smoking was more evident in males than in females, and in squamous and small-cell types, as a group, than in adenocarcinoma. Forty-four per cent of the women with bronchial cancer were non-smokers, their predominant tumour being adenocarcinoma, and in them on association could be detected with place of residence or occupation. There was no strong evidence of an association with the use of kerosene or gas for cooking; 23 did not use kerosene. The cause of the cancer in these non-smoking women remains unknown.