Fatal Second Impact Syndrome in Rowan Stringer, A 17-Year-Old Rugby Player.

Second impact syndrome (SIS) is associated with malignant brain swelling and usually occurs in young athletes with one or more prior, recent concussions. SIS is rare and some dispute its existence. We report a case of SIS in Rowan Stringer, age 17, a rugby player who sustained a fatal brain injury despite prompt medical therapy including decompression surgery. The cause of the massive brain swelling was initially unknown. An inquest revealed Rowan's text messages to friends describing symptoms from two prior, recent rugby brain injuries, likely concussions, within 5 days of the fatal blow and confirming the diagnosis of SIS.

Predictors for admission of children with periorbital cellulitis presenting to the pediatric emergency department.

OBJECTIVES: To identify demographic and clinical characteristics associated with admission because of periorbital cellulitis (PC) in children. METHODS: Records of children aged 0 to 18 years with PC who visited our tertiary emergency department (ED) in 2004 were reviewed. We calculated a cumulative number of local ocular symptoms in patients that included swelling/edema, redness/erythema, presence of discharge, pain, conjunctival injection, and shut eye. A binary logistic regression analysis was performed to identify predictors of admission for PC. RESULTS: A total of 89 children were included in the analysis; 39 (44%) of them were admitted to the ward. A cumulative number of local symptoms associated with PC and temperature in the ED served as significant predictors of hospitalization (odds ratio, 2.5; P = 0.005; and odds ratio, 2.0; P = 0.04, respectively). Among individual local symptoms, only swelling/edema was found to significantly predict admission in univariate analysis (P = 0.03). Considerable variation was documented in intravenous and oral antibiotics prescribed in the ED. CONCLUSIONS: Combination of local ocular symptoms and body temperature are positively associated with admission from the ED. Future research should concentrate on evaluating the suggested score we used in this cohort to validate it and evaluate its generalizability. Devising such scoring can help clinicians determine guidelines for admission of children with PC.