Risk Factors for Ankle Fractures in Asian Adolescents Seen in a Pediatric Emergency Department.

OBJECTIVES: Pediatric ankle injuries remain one of the most common presenting complaints to the pediatric emergency department (PED). In this study, we aimed to describe risk factors associated with simple ankle fractures and ankle fractures that require surgery, among adolescents presenting to the PED with ankle injuries. METHODS: We analyzed a retrospective cohort study of adolescents 12 to 16 years old who presented to our PED with an acute ankle injury and received an ankle radiograph from November 1, 2016, to October 31, 2017. Demographic, anthropometric variables, physical examination findings including those of the Ottawa Ankle Rules were obtained. We recorded any surgical interventions required, as well as follow-up and to return to physical activity. RESULTS: Five hundred fifty-six cases of adolescent ankle injuries were reviewed, of which 109 adolescents had ankle fractures, whereas 19 had ankle fractures requiring surgery. Sports-related injuries remained the most common cause of ankle fractures. Age (adjusted odds ratio [aOR], 0.69; 95% confidence interval [CI], 0.56-0.83; P < 0.001), male sex (aOR, 2.12; 95% CI, 1.34-3.35; P < 0.001), clinical findings of tenderness over the lateral malleolus (aOR, 3.13; 95% CI, 1.74-5.64; P < 0.001) or medial malleolus (aOR, 3.55; 95% CI, 2.18-5.78; P < 0.001), and inability to walk (aOR, 3.09; 95% CI, 1.95-4.91; P < 0.001) were significant independent risk factors for ankle fractures.Patients with a weight more than 90th centile for age were at greater risk of ankle fractures requiring surgery (aOR, 2.64; 95% CI, 1.05-6.64; P = 0.04). CONCLUSIONS: We found that younger age, male sex, and clinical findings in the Ottawa Ankle Rules correlated well with predicting ankle fractures and are well suited for application in the Southeast Asian population. Weight greater than the 90th percentile for age was a significant risk factor for ankle fractures requiring surgery.

Assessment of the Understanding of Concussion and Care Protocols Amongst Student Athletes and Coaches: A Qualitative Study.

Background: Pediatric sports-induced concussions have become a topic of interest and concern in the scientific community. Already, the literature is rich with studies that have identified numerous short-term and long-term consequences of childhood sports-induced concussions. However, there are very few studies that have identified how well the students who participate in concussion-prone sports and their coaches understand these consequences and how they can be avoided. This study aimed to explore student athletes' and their coaches' understanding of the concept of concussion and how it is managed both immediately after the injury occurs and during long-term recovery. Methods: This study utilized a qualitative design. The study was conducted in local and international schools in Singapore. Participants were recruited through purposive sampling. 42 student athletes aged 13-18 who participated in rugby, softball, football, cricket, volleyball, and/or water polo were recruited. Fourteen coaches who coached these same sports were also recruited. Four focus groups and three semi-structured interviews were conducted. Data collected were then analyzed with thematic analysis. Risk factors were assessed through four domains of focus: understanding of what concussion is; attitudes toward concussion; existing protocols for treating concussion; and return-to-school and return-to-play protocols. As this is a qualitative study, outcome measures were not identified. Results: Analysis of the data revealed four themes for each group. For student-athletes these included: limited understanding of concussion; non-reporting of injuries; variable supervision of athletes; and a lack of established return-to-school and return-to-play guidelines. For coaches these included: variable understanding of concussion; insufficient formal training in concussion management; limited medical support in managing injuries; and lack of understanding and adherence to return-to-school and return-to-play protocols. Conclusions: Of the themes identified, the most pressing was a lack of clearly defined return-to-play guidelines. This is an urgent issue that needs to be jointly addressed by healthcare professionals and schools with evidence-based guidelines.

Actin chromobody imaging reveals sub-organellar actin dynamics.

The actin cytoskeleton plays multiple critical roles in cells, from cell migration to organelle dynamics. The small and transient actin structures regulating organelle dynamics are challenging to detect with fluorescence microscopy, making it difficult to determine whether actin filaments are directly associated with specific membranes. To address these limitations, we developed fluorescent-protein-tagged actin nanobodies, termed 'actin chromobodies' (ACs), targeted to organelle membranes to enable high-resolution imaging of sub-organellar actin dynamics.

Risk Stratification of Paediatric Sports Injuries Seen at a Tertiary Hospital.

INTRODUCTION: In this study, we described paediatric sports injuries seen in the paediatric emergency department of a large, tertiary paediatric hospital in Singapore and evaluated risk factors for severe sports injuries. METHODS: This is a retrospective review of a paediatric trauma surveillance registry from February 2012 to October 2017, including patient demographics, type of sports, circumstances, type of injuries, and clinical management in the hospital. Patients 5 to 17 years old with a sports-related injury were included. We performed logistic regression to identify predictors of severe sports injuries (defined by Injury Severity Score of ≥9), injuries requiring hospitalisation, trauma team activation, resuscitation, or those that resulted in death. RESULTS: Among 10,951 patients analysed, the most common injuries sustained were fractures (4,819, 44.0%), sprains and contusions (3,334, 30.4%). For patients with severe injuries, the median length of hospital stay was 2 days (IQR 1-3 days), and time away from sports was 162 days (IQR 104-182 days). Predictors for severe injuries include transportation by emergency medical service (aOR 6.346, 95% CI 5.147-7.823), involvement in rugby (aOR 2.067, 95% CI 1.446-2.957), neurological injuries (aOR 4.585, 95% CI 2.393-4.365), dislocations (aOR 2.779, 95% CI 1.744-4.427), fractures (aOR 1.438, 95% CI 1.039-1.990), injuries to the head and neck (aOR 2.274, 95% CI 1.184-4.365), and injuries to the abdomen and pelvis (aOR 5.273, 95% CI 3.225-8.623). CONCLUSION: Predictors for severe sports injuries identified may aid in risk stratification and resource allocation.

Parental knowledge and beliefs on the use of child car restraints in Singapore: a qualitative study.

INTRODUCTION: Road traffic injuries and fatalities represent a significant public health problem. In Singapore, compliance with appropriate child car restraints (CCRs) is poor. We aimed to understand parental knowledge, beliefs and barriers regarding the use of CCRs. METHODS: In this qualitative study, we conducted five focus group discussions with parents who drive with their children in private cars. Participants were recruited using the KK Women's and Children's Hospital's social media page. Guiding questions were derived by consensus following literature review and adaptation to the Singapore context, exploring parental perceptions of CCR use. Focus group interviews were then transcribed and analysed. RESULTS: 33 participants were recruited, with an age range of 28‒46 (mean age 35.5) years. They had a total of 46 children with ages ranging from 2.5 months to 14 years (mean age 4.2 years). Three key themes were identified: parental knowledge regarding CCRs, barriers to CCR use, and suggestions to increase CCR compliance. Barriers to compliance included lack of knowledge, difficult child behaviour and cultural norms. A multipronged approach was proposed to increase CCR use, including educating the public, reinforcing positive behaviour, legal enforcement as a deterrent to non-compliance, increasing CCR installation services, providing CCRs for taxi users and offering financial incentives. CONCLUSION: Non-compliance to CCR use is multidimensional, including multiple potentially modifiable factors. This study could inform ongoing collaborative injury prevention efforts among healthcare professionals, industry partners and the traffic police, using public education and outreach to reduce the burden of road traffic injuries.

Effect of virtual reality headset wear on the tear film: A randomised crossover study.

PURPOSE: To compare the effects of virtual reality headset wear and conventional desktop computer display use on ocular surface and tear film parameters. METHODS: Twenty computer operators were enrolled in a prospective, investigator-masked, randomised crossover study. On separate days, participants were randomised to 40 min of continuous virtual reality headset wear or conventional desktop computer display use. Outer eyelid and corneal temperatures, tear film lipid layer grade, and non-invasive tear film breakup time were measured at baseline and immediately following the 40-minute exposure period. RESULTS: Virtual reality headset wear resulted in increases in outer eyelid (mean difference +0.5 ±â€¯0.6 °C; p < 0.001) and corneal temperatures (mean difference, +0.4 ±â€¯0.6 °C; p = 0.004), relative to conventional desktop computer display use. These increases were associated with significant improvements in tear film lipid layer grade (median difference, +1 grade; interquartile range, 0 to +2 grades; p < 0.001) and non-invasive tear film breakup time (mean difference, +7.2 ±â€¯12.4 s; p = 0.02). CONCLUSIONS: Clinically significant improvements in lipid layer thickness and tear film stability were observed with virtual reality headset wear, despite producing only modest increases in ocular temperatures relative to conventional desktop computer display use. These findings would suggest that virtual reality headset wear demonstrates potential for dry eye relief for computer operators in the modern workplace environment.

Randomised trial of the clinical utility of an eyelid massage device for the management of meibomian gland dysfunction.

PURPOSE: To compare the single application and two week treatment effects of device-applied (Eyepeace) and manually-applied eyelid massage techniques, as an adjunct to warm compress therapy, on ocular surface and tear film parameters. METHODS: Twenty participants (11 females, 9 males; mean age, 27 ±â€¯11 years) with dry eye symptoms were recruited in a two week, investigator-masked, randomised, contralateral-eye trial. Following 10 min of warm compress therapy application (MGDRx EyeBag®) on both eyes, eyelid massage therapy was applied to one eye (randomised) by device, and to the fellow eye by manual eyelid massage, once daily for 14 days. Ocular surface and tear film measurements were conducted at baseline, and 15 min post-application by a clinician, then again after 14 days of self-administered daily treatment at home. RESULTS: Baseline clinical measurements did not differ between the treatment groups (all p > 0.05). Following two weeks of treatment, tear film lipid layer grade improved significantly with device massage (p = 0.008), and was marginally greater than manual massage by less than 1 grade (p = 0.03). Although immediate post-treatment improvements in tear film stability were observed in both groups (both p < 0.05), no significant long-term cumulative effects or inter-treatment differences in stability measures were detected (all p > 0.05). Visual acuity, tear meniscus height, conjunctival hyperaemia, ocular surface staining, and meibomian gland dropout did not change during the treatment period (all p > 0.05). CONCLUSIONS: Two weeks of treatment with the eyelid massage device, as an adjunct to warm compress therapy, effected marginally greater improvements in tear film lipid layer thickness than the conventional manual technique, which were statistically but not clinically significant. Future parallel group trials with longer treatment periods and a greater range of disease severity are required.

A review of stroller-related and pram-related injuries to children in Singapore.

Prams and strollers are commonly used in daily childcare. We aim to study the type and severity of injuries associated with prams and strollers in an Asian population. We performed a retrospective review of children below the age of 6 who presented to a tertiary paediatric hospital in Singapore, from January 2012 to June 2015, with such injuries. There were 248 pram-related and stroller-related injuries. The median age was 12.5 months old. 69 (27.8%) sustained open wounds, 17 (6.9%) suffered fractures or dislocations and 2 children had significant head injuries. 29 patients (11.7%) sustained injuries while on stairs or escalators. Most of the injuries (197 cases, 79.4%) occurred despite adult supervision. The need for intervention was associated with older age and entrapment injuries (p<0.001). Only appropriately sized prams and strollers without exposed hinges should be used. These should not be deployed on stairs and escalators.

Prehospital Transport for Pediatric Trauma: A Comparison of Private Transport and Emergency Medical Services.

OBJECTIVES: We describe the demographics of pediatric patients with trauma transferred using private transport (PT) versus emergency medical services (EMS) and evaluate the potential impact on their treatment and outcome. METHODS: We accessed data from our national trauma registry, a prospectively collected database. Data were extracted on all patients with trauma admitted to our institution between January 2011 and June 2013, with injury severity score (ISS) higher than 8. We categorized unstable injuries as head injuries, spinal injuries, or proximal long bone fractures. Major trauma was defined as the presence of any of the following: ISS of 16 or higher, intensive care unit (ICU) admission or death. RESULTS: Ninety children were studied, including 27 major trauma and 66 unstable injuries; 69 patients (77%) used PT. Most patients with major trauma (17/27, 63%) and unstable injuries (50/66, 76%) used PT. Compared with EMS patients, PT patients were younger, smaller, took longer for emergency department physician review and stayed longer in the emergency department. Rates of ICU admission were similar in both groups, but length of stay in ICU and total hospital stay were shorter in the PT group despite similar proportions of major trauma and unstable injuries as well as median ISS. Each group had 1 mortality. CONCLUSIONS: Most children with major trauma and unstable injuries were brought by PT, risking deterioration en route. Nevertheless, this does not seem to translate to worse outcomes overall.

A prospective surveillance of paediatric head injuries in Singapore: a dual-centre study.

OBJECTIVE: To study the causes of head injuries among the paediatric population in Singapore, and the association between causes and mortality, as well as the need for airway or neurosurgical intervention. DESIGN: This is a prospective observational study utilising data from the trauma surveillance system from January 2011 to March 2015. SETTING: Paediatric emergency departments (EDs) of KK Women's and Children's Hospital and the National University Health System. PARTICIPANTS: We included children aged <16 years presenting to the paediatric EDs with head injuries who required a CT scan, admission for monitoring of persistent symptoms, or who died from the head injury. We excluded children who presented with minor mechanisms and those whose symptoms had spontaneously resolved. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary composite outcome was defined as death or the need for intubation or neurosurgical intervention. Secondary outcomes included length of hospital stay and type of neurosurgical intervention. RESULTS: We analysed 1049 children who met the inclusion criteria. The mean age was 6.7 (SD 5.2) years. 260 (24.8%) had a positive finding on CT. 17 (1.6%) children died, 52 (5.0%) required emergency intubation in the ED and 58 (5.5%) underwent neurosurgery. The main causes associated with severe outcomes were motor vehicle crashes (OR 7.2, 95% CI 4.3 to 12.0) and non-accidental trauma (OR 5.8, 95% CI 1.8 to 18.6). This remained statistically significant when we stratified to children aged <2 years and performed a multivariable analysis adjusting for age and location of injury. For motor vehicle crashes, less than half of the children were using restraints. CONCLUSIONS: Motor vehicle crashes and non-accidental trauma causes are particularly associated with poor outcomes among children with paediatric head injury. Continued vigilance and compliance with injury prevention initiatives and legislature are vital.