Extradural hematoma in children: case series of 33 patients.

BACKGROUND: Conservative management of extradural hematomas (EDH) is relatively recent in the literature and there are few papers reporting on the pediatric population. OBJECTIVE: We conduct a 20-month assessment of the treatment administered for EDH at a pediatric intensive care unit (PICU). METHODS: A retrospective case series in the period described above. The main variables studied were the weight and age of the patients, the Pediatric Trauma Score, the mechanism of injury, clinical features, CT findings and the Glasgow Coma Scale score on arrival, and after 12 and 24 h. Also analyzed was whether during primary care either surgical intervention or initial conservative management was recommended. RESULTS: In the 20 months analyzed, 33 EDH patients were admitted to the PICU. Patients had a mean age of 7.42 ± 4.66 years, mean weight of 31.16 ± 16.16 kg and mean Pediatric Trauma Scores of 7.03 ± 3.71. Out of the total sample, surgery was indicated in 12 patients (36.4%) in primary care and 21 patients (63.6%) were treated with initial conservative management. Most of the patients who were given conservative treatment had a Glasgow Coma Scale score of 15 on arrival and maintained this level throughout the hospital stay. The most prevalent sites of the hematomas were the temporal and parietal regions and the most common associated injury was skull fracture. CONCLUSION: In this case series, conservative treatment of EDH was most frequent; however, which factors are involved in this decision has to be better studied.

Vancomycin-associated Nephrotoxicity and Risk Factors in Critically Ill Children Without Preexisting Renal Injury.

BACKGROUND: A recent systematic review concluded that critically ill pediatric patients have higher odds of vancomycin-related nephrotoxicity [odds ratio (OR): 3.61, 95% CI: 1.21-10.74]. We aimed to assess the incidence and risk factors for vancomycin-associated nephrotoxicity in critically ill children without preexisting renal injury. METHODS: A cohort of children admitted to a pediatric intensive care unit, from 2011 to 2016 treated with vancomycin without preexisting renal injury. The main diagnosis, therapeutic interventions and medications administered in this period were evaluated. Generalized estimating equation models were used to assess the association between clinical covariates and the dependent variable pediatric risk, injury, failure, loss, end-stage renal disease (pRIFLE). RESULTS: Hundred ten patients, representing 1177 vancomycin days, were analyzed. Vancomycin-associated nephrotoxicity was seen in 11.8%. In a multivariate model, higher vancomycin doses were not associated with poorer renal function (P = 0.08). Higher serum vancomycin levels were weakly associated with pRIFLE classification (OR: 1.05, 95% CI: 1.02-1.07). Furosemide or amphotericin B in addition to the vancomycin treatment was associated with impaired renal function (OR: 2.56, 95% CI: 1.38-4.8 and OR: 7.7 95% CI: 2.55-23, respectively). CONCLUSIONS: Vancomycin-associated nephrotoxicity in acute ill children without preexisting renal injury, measured with pRIFLE, is close to 11.8%. Furosemide and amphotericin B in addition to the vancomycin treatment are strong predictors of worse pRIFLE scores. The influence of acute kidney injury status at pediatric intensive care unit admission and the method used for renal function assessment might influence the incidence of vancomycin-associated nephrotoxicity and its associated risk factors.