Splinting of Low-Risk Pediatric Fractures.

This review covers common orthopedic injuries seen after acute traumatic injury. A thorough physical examination and radiographic review of these injuries are key to ensuring appropriate management. Although many injuries may require urgent or emergent orthopedic consultation and management, this review focuses on injuries that are low-risk and amenable to splinting with outpatient orthopedic follow-up.

Pediatric musculoskeletal infections.

Purpose Of Review: The aim of this article is to review the recent guidelines and literature regarding the diagnosis and the treatment of common pediatric musculoskeletal infections: septic arthritis, osteomyelitis, pyomyositis, and Lyme disease.

Recent Findings: In the last decade, a better understanding of the causative organisms of common bacterial infections, including Kingella , leads to prompt targeted antimicrobial coverage in all musculoskeletal infections. Prompt diagnosis and treatment continues to be the mainstay in the treatment of children with osteoarticular infections.

Seasonal Variation of Pediatric Septic Arthritis in the United States: A PHIS Database Study.

Background: The presence of seasonal patterns in pediatric septic arthritis cases is a common orthopaedic teaching. Seasonal variation has been seen in centers outside of the United States and with other inflammatory and infectious joint-related conditions within the country, but it is unknown if a seasonal pattern exists among different regions of the United States. The purpose of this study was to examine the seasonal variation of septic arthritis within specific regions across the United States.

Pediatric Fracture Epidemiology and US Emergency Department Resource Utilization.

Objective: Fractures are common childhood injuries that result in emergency department (ED) visits. National trends in pediatric fracture epidemiology and resource utilization are not well described. Our objective is to analyze national trends in pediatric fracture epidemiology, ED disposition, and ED resource utilization from 2010 to 2015.

The Initial Approach to the Multisystem Pediatric Trauma Patient.

Trauma remains the leading cause of morbidity and mortality in children and youth 1 to 19 years old in the United States. Providing timely care with a systematic approach is essential for emergently addressing life-threatening injuries and ongoing assessment. The primary survey is focused on identifying and managing life-threatening injuries.

Yield of Plain Radiography in Addition to Ultrasound Among Children with Hip Pain.

Background: Children with limp or hip pain often undergo radiographs and ultrasound as part of their initial evaluation. Previous research suggests that hip radiography may have limited utility, and early use of ultrasound may safely reduce the use of radiographs.

Objectives: We sought to assess the utility of radiography in addition to ultrasound by evaluating the rate of bony abnormalities present on hip radiographs among children with and without effusion on ultrasound.

Pediatric spinal cord injury without radiographic abnormality in the era of advanced imaging.

Purpose Of Review: The current review describes the current evidence on pediatric spinal cord injury without radiographic abnormality (SCIWORA) with attention to the definition, epidemiology, and clinical presentation of the condition, as well as common MRI findings, management strategies, and outcomes.

Recent Findings: Recent literature demonstrates that with more widespread MRI use, our understanding of SCIWORA has improved. The new literature, although still limited, provides a more granular conceptualization of patterns of injury as well as potential prognostic stratification of patients based on MRI findings.

Outcomes of pediatric patients with persistent midline cervical spine tenderness and negative imaging result after trauma.

Background: There is little evidence to guide management of pediatric patients with persistent cervical spine tenderness after trauma but with negative initial imaging study findings. Our objective was to determine the prevalence of clinically significant cervical spine injury among pediatric blunt trauma patients discharged from the emergency department with negative imaging study findings but persistent midline cervical spine tenderness.

Methods: We performed a single-center, retrospective study of subjects 1 year to 15 years of age discharged in a rigid cervical spine collar after blunt trauma over a 5-year period.

Pediatric cervical spine injury evaluation after blunt trauma: a clinical decision analysis.

Study Objective: Although many adult algorithms for evaluating cervical spine injury use computed tomography (CT) as the initial screening modality, this may not be appropriate in low-risk children, considering radiation risks. We determine the optimal initial evaluation strategy for cervical spine injury in pediatric blunt trauma.

Methods: We constructed a decision analysis tree for a hypothetical population of patients younger than 19 years with blunt trauma, using 3 strategies: clinical stratification, screening radiographs followed by focused CT if the radiograph result was positive, and CT.

Cardiac output assessed by non-invasive monitoring is associated with ECG changes in children with critical asthma.

The primary aim of this study was to determine changes in CI and SI, if any, in children hospitalized with status asthmatics during the course of treatment as measured by non-invasive EC monitoring. The secondary aim was to determine if there is an association between Abnormal CI (defined as <5 or >95 % tile adjusted for age) and Abnormal ECG (defined as ST waves changes) Non-invasive cardiac output (CO) recordings were obtained daily from admission (Initial) to discharge (Final). Changes in CI and SI measurements were compared using paired t tests or 1-way ANOVA.

Serum 25-hydroxyvitamin D levels among Boston trainee doctors in winter.

As indoor workers, trainee doctors may be at risk for inadequate vitamin D. All trainee doctors (residents) in a Boston pediatric training program (residency) were invited to complete a survey, and undergo testing for serum 25-hydroxyvitamin D [25(OH)D], PTH, and calcium during a 3-week period in March 2010. We examined the association between resident characteristics and serum 25(OH)D using Chi2 and Kruskal-Wallis test and multivariable linear and logistic regression.

Wingate Anaerobic Test peak power and anaerobic capacity classifications for men and women intercollegiate athletes.

The Wingate Anaerobic Test (WAnT) has been established as an effective tool in measuring both muscular power and anaerobic capacity in a 30-second time period; however, there are no published normative tables by which to compare WAnT performance in men and women intercollegiate athletics. The purpose of this study was to develop a classification system for anaerobic peak power and anaerobic capacity for men and women National Collegiate Athletic Association (NCAA) Division I college athletes using the WAnT. A total of 1,585 (1,374 men and 211 women) tests were conducted on athletes ranging from the ages of 18 to 25 years using the WAnT.

Retrospective evaluation of a computerized physician order entry adaptation to prevent prescribing errors in a pediatric emergency department.

Objective: The goal was to determine the impact on medication prescribing errors of adding a pediatric medication list (quicklist) to a computerized physician order entry system in a pediatric emergency department.

Methods: The quicklist is a drug dosing support tool that targets the most common medications in our clinical setting. We performed a retrospective comparison of orders from 420 randomly selected visits before and after quicklist introduction.