Magdy W. Attia

Patterns of injury associated with routine childhood falls

Objective: To identify the pattern of injuries associated with routine childhood falls. Methods: Retrospective chart review of patients at most 12 years presenting to a childrens hospital emergency department with complaint of a fall. Patients were classified into 3 age groups (<2, 2-4, and 5-12 years) and analyzed for the type of fall and diagnosis. Results: Seven hundred eighty-seven patients were enrolled. Mean age was 5.7 years. Fifty-six percent were boys. The types of falls reported were categorized as a fall down steps, from patients own height, from an object, and other. In all 3 groups, the most common fall was fall from an object (50%, 50%, and 48%, respectively). There were 91 (12%) patients in the younger-than-2-year-old age group and 235 (30%) in the 2- to 4-year-old age group. Both groups commonly fell from a bed/chair (35% and 25%, respectively). In the youngest group, the most frequent diagnosis was head injury (41%; odds ratio [OR], 5.0; 95% confidence interval [CI], 3.0-8.1). Children ages 5 to 12 years numbered 461 (58%) and most commonly fell from playground equipment (26%) sustaining a fracture (65%; OR, 3.1; 95% CI, 2.3-4.3). Of these, 77% were in the upper extremity (arm fracture; OR, 41; 95% CI, 22-79). Conclusions: In children who presented to a childrens hospital emergency department with a fall, fall from an object was the most common type. Those younger than 2 years, most commonly fell from a bed/chair and sustained head injury. Children 5 to 12 years old were likely to fall from playground equipment and fracture their arm. These findings may be helpful to clinicians who evaluate routine childhood falls.

Clinical predictors of respiratory syncytial virus infection in children.

Aim: The aim of this study was to develop a clinical prediction model that identifies respiratory syncytial virus (RSV) infection in infants and young children.

Influenza A-associated meningoencephalitis.

Complications of influenza such as meningitis or encephalitis are rarely seen in the United States. There have been multiple case reports of patients in other parts of the world involving children with severe illness, neurologic sequelae, or death. Many of these reported cases were during influenza epidemics. We report on 2 children who presented as isolated cases in the United States with a less severe course and better outcome than previously reported.

An Unusual Cause of Limp in a Toddler

An 11-month-old girl presented to the pediatric emergency department (ED) with a 1-day history of refusal to bear weight on the right lower extremity. In the 2 weeks prior, her parents had noted their previously agile walker to be crawling more often. This progressed to a limpand,finally, absolute refusal tobearweight.Therewasnohistoryof traumaor fever.Theprimarycarephysicianhad initially suspected toxic synovitis and recommended supportive care. In the ED, the child was fussy but consolable. Her vital signs were within normal limits. She refused to bear weight on her right foot (Figure 1). The ankle was noted to be edematous, warm to the touch, and diffusely tender to palpation, and it had diminished creases when compared with the left ankle. Her examination was otherwise unremarkable. Serum laboratory studies, including aCBC count, antineutrophilic antibody, blood culture, Lyme titers, and inflammatorymarkers, were all within normal limits, with the exception of an elevatedWBC count of 16,400 K/UL. Radiographs of the ankle revealed a lucency in the posterior aspect of the talus and soft tissue swelling of the ankle joint (Figure 2).Magnetic resonance imaging (MRI) was subsequently completed and revealed a 7-mm abscess in the lateral subcutaneous soft tissues. Throughout the talus, there was diffusely decreased T1-weighted signal intensity, corresponding to increased T2-weighted signal intensity (Figure 3). For further discussion on this case, see page 297. For the diagnosis and teaching points, see page 306. To view the entire collection of Images in Emergency Medicine, visit www.annemergmed.com