S.V. Soundappan

Trampoline trauma in children: Is it preventable?

Objectives: Trampoline injuries represent a preventable cause of injury in children. This study identified the characteristics of children injured while using trampolines who presented to a pediatric trauma center in Sydney, Australia. Methods: The Pediatric Trauma Database at our institution was reviewed to identify children with trampoline-related injuries between January 1999 and June 2008. Data collected included age, sex, Injury Severity Score, anatomical region injured, type of injury, mechanism of injury, site of injury and surface fallen onto, level of supervision, treatment, and hospital length of stay. Results: Over the 9.5-year review period, 383 children presented with trampoline-related injuries: 193 (50.4%) were female. Just over a quarter (n = 106, 27.7%) were treated and discharged the same day. The remaining patients accounted for 725 hospital bed days with a mean length of stay of 2.3 days. The most common area of the body injured was the upper limb (n = 246, 64.2%), with a fall from the trampoline to the ground being the most frequent mechanism of injury (n = 257, 67.1%). The majority (n = 345, 90.1%) of children were injured in their home or at the home of a friend or relative. Surgery was required in 236 (61.6%), with closed reduction of an upper limb fracture being the most common procedure (n = 107, 27.9%). Conclusions: Trampoline-related injuries remain common in children. Implementation of current guidelines and the introduction of innovative trampoline designs should reduce the risk of this injury in children.

Delayed diagnosis of anorectal malformations: are current guidelines sufficient?

Aim:  To determine the frequency and presenting features of infants with delayed diagnosis of anorectal malformations (ARM) referred to an Australian tertiary paediatric institution.

Off-Road Vehicle Trauma in Children: A New South Wales Perspective

Objective: There is paucity of data on off-road vehicle injuries in children in Australia. We performed a retrospective study from 1998 to 2003 to analyze the frequency and nature of injuries in children involved in off-road vehicle crashes in the state of New South Wales. Methods: Medical records were identified from search of the trauma database and hospital medical records database for off-road (all-terrain) vehicles. Results: A total of 271 children were identified, 86% of whom were boys. The mean age was 10 years (range, 2-16 years); and the mean length of stay, 5.8 (9) days (range, 1-40 days). The mean injury severity score was 6 (5.9). Most were drivers (85%). Injury mechanism was falls in 161; collision with stationary object, 54; moving object, 4; rollovers, 7; and others, 8. Eighty-four percent were on 2 wheelers, whereas 11% were quad bikes, and the rest were on tricycles or other vehicles. Distribution of the body region injured was head and neck in 66 patients; face, 51; chest, 25; abdomen, 36; pelvis, 5; spines, 14; upper limbs, 96; and lower limbs, 116. Only 55% were helmeted at the time of the incident. Sixty-five percent of these children required surgical treatment. Most were fractures (98) followed by soft tissue injuries (49). Seventeen had posthead injury sequelae requiring rehabilitation support, and 21 required multiple surgeries. There were 7 deaths during the study period in New South Wales. Conclusions: Off-road motor vehicle injuries are a significant problem in children. There are no legal safety regulations for use of these vehicles. With the increasing sales of these vehicles, the incidence of injury may rise. There seems a need for education and legislation in relation to the safety issues concerned with these vehicles.

Appendicitis and low-flow priapism in children

Priapism is a sustained erection that is maintained for over 4 hours in the absence of sexual stimulation [Postgrad Med J. 2006;82(964):89-94; J Urol. 2003;170:1318-1324]. Distinction is made between low- and high-flow variants [J Urol. 2003;170:1318-1324; Cardiovasc Intervent Radiol. 2002;25(4):326-329]. Low-flow priapism (LFP) and acute appendicitis are rarely associated. Including ours, there are 4 cases reported in the literature, all of which have occurred in children. The complications of LFP are potentially serious and include loss of the phallus altogether. Treatment of LFP is should be prompt and is the same irrespective of the etiology.

Pediatric high-flow priapism and super-selective angiography—an Australian perspective

High-flow priapism is an uncommon entity in the pediatric and adolescent population. It is usually caused by perineal trauma. Here we describe the experience of our institution in this condition over the past 10 years, the various treatment options available, and the successful application of super-selective angiographic embolization as our treatment modality of choice. Included here is the case of a 4-year-old boy (case 3) who, to our knowledge, is the youngest patient described with this condition in the literature.

Neurocognitive outcomes in children following immersion: a long-term study

Objective To investigate long-term neurocognitive outcomes after a near-drowning incident in children who were deemed neurologically intact on discharge from hospital. Design A prospective cohort study of near-drowning children. Setting 95 drowning and near-drowning admissions, 0–16 years of age, from January 2009 to December 2013, to The Children’s Hospital at Westmead, Sydney, NSW, Australia. Participants 23 children both met the criteria and had parental consent for the study. Main outcome measures Identification of the long-term deficits in behaviour, executive function, motor skills, communicative skills and well-being over a 5-year period. Assessment was undertaken at 3–6 months, 1 year, 3 years and 5 years after near-drowning at clinic visits. Physical developmental screening and executive function screening were done using Behavior Rating Inventory of Executive Function-Preschool version (BRIEF-P) and BRIEF. Result 95 drowning and near-drowning episodes occurred during the study period. 10 (11%) children died, 28 were admitted to the paediatric intensive care unit and 64 directly to a ward. 3 children died in emergency department, 7 children had severe neurological deficit on discharge from the hospital. 23 were subsequently recruited into the study; 5 (22%) of these children had abnormalities in behaviour and/or executive function at some during their follow-up. Conclusion Children admitted to hospital following a near-drowning event warrant long-term follow-up to identify any subtle sequelae which might be amenable to intervention to ensure optimal patient outcome.

Transition zone pull-through in Hirschsprung's disease: a tertiary hospital experience.

Pull‐through of ganglionic bowel is essential for successful treatment of Hirschsprungs disease. We studied the incidence of transition zone pull‐through in our institution and compared its outcome with ganglionic bowel pull‐through.