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A 2-year-old girl sustained severe injury to 2 fingers from a home paper shredder. This case illustrates the risk of injury from paper shredders, which are increasingly common household items. Toddlers are at risk of finger injury and amputation. The US Consumer Product Safety Commission performed an investigation of reported injuries and the characteristics of paper shredders that might have contributed to the injuries, and we summarize their findings. [ABSTRACT FROM AUTHOR]

Re-evaluation of medical findings in alleged shaken baby syndrome and abusive head trauma in Norwegian courts fails to support abuse diagnoses. In case number 6, we described clavicle and rib fractures, but unfortunately, we did not report that there was also a scapula fracture. Corrigendum to the paper 'Re-evaluation of medical findings in alleged shaken baby syndrome and abusive head trauma in Norwegian courts fails to support abuse diagnoses'. [Extracted from the article]

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The introduction of YOLOv9, the latest version of the you only look once (YOLO) series, has led to its widespread adoption across various scenarios. This paper is the first to apply the YOLOv9 algorithm model to the fracture detection task as computer‐assisted diagnosis to help radiologists and surgeons to interpret X‐ray images. Specifically, this paper trained the model on the GRAZPEDWRI‐DX dataset and extended the training set using data augmentation techniques to improve the model performance. Experimental results demonstrate that compared to the mAP 50–95 of the current state‐of‐the‐art model, the YOLOv9 model increased the value from 42.16% to 43.73%, with an improvement of 3.7%. The implementation code is publicly available at https://github.com/RuiyangJu/YOLOv9‐Fracture‐Detection. [ABSTRACT FROM AUTHOR]

Fourth, the Letter raises a number of additional issues: The Letter states that "The National Association of Medical Examiners has in place a procedure for providing contact information for surveys such as this in order to make sure that the sampling is complete and unbiased. To be clear, our paper calls for a long-overdue discussion about what information should and should not be used in forensic pathology decisions, and a collective recognition that cognitive bias occurs in forensic pathology decision-making - as it can in any decision-making task. In the second set of data from our experimental study, the research question was whether forensic pathology decisions were biased by nonmedical and irrelevant contextual information in general, I not i race specifically. Remember that our paper presents the first data to examine bias in forensic pathology decision-making, and as we clearly stated, "Our two data sets are the first step in examining biases in postmortem decision-making, and they do not answer all the questions.". [Extracted from the article]

Introduction: An outbreak of the COVID-19 disease in 2020 and resulting social restrictions forced many medical facilities to modify admission protocols and increased the use of health services. The stay-at-home orders also contributed to a change in the volume of the emergency admissions as well as their causes. Materials and methods: The available electronic databases were searched for papers concerning pediatric trauma admissions, referrals, and visits during the coronavirus outbreak and in the previous year. The quality of included papers was assessed via National Institutes of Health National Heart, Lung, and Blood Institute (NIH NHLBI) Study Quality Assessment Toolbox. Results: The overall workload in pediatric emergency medical care during the COVID-19 outbreak declined by 40.13% (95% CI 18.7–61.6) compared to the previous year. A massive decline in the pediatric trauma admissions was observed during the coronavirus outbreak. The sport-related accidents were supplanted mainly by those that occurred at home. The child abuse injuries arising during the outbreak seemed to remain undetected. [ABSTRACT FROM AUTHOR]

The article presents abstracts on pediatrics which include the risk factors with paediatric burns, non-accidental injuries and trauma in children.

Background and Aim: It is widely acknowledged that children should participate in healthcare decisions, service development and even setting research agendas. Dental traumatology is a major component of paediatric dentistry practice and research. However, little is known about young patients' contribution to new knowledge in this field. The aim of the study was to establish the extent to which children are involved in contemporary dental trauma research and to evaluate the quality of the related literature.Material and Methods: A systematic review of the dental trauma literature was conducted from 2006 to 2014. The electronic databases, MEDLINE and Scopus, were used to identify relevant studies. The selected papers were independently examined by five calibrated reviewers. Studies were categorized by the degree of children's involvement and appraised using a validated quality assessment tool.Results: The initial search yielded 4374 papers. After application of the inclusion and exclusion criteria, only 96 studies remained. Research on children accounted for 87.5% of papers, and a proxy was involved in 4.2%. Children were engaged to some degree in only 8.3% of studies, and there were no studies where children were active research participants. In the quality assessment exercise, papers scored, on average, 57% (range = 14-86%).Conclusion: There is scope to encourage more active participation of children in dental trauma research in the future. Furthermore, there are some areas where the quality of research could be improved overall. [ABSTRACT FROM AUTHOR]

All the 11 members of the South-East Asia Region (SEAR) of the World Health Organization are categorised as low- and middle-income countries. This region has over a quarter of the world's total population but comprises about one-third of the world's unintentional injury-related deaths. There is a paucity of good-quality mortality and morbidity data from most of these countries. This is the first systematic review of community-based surveys on child injuries that summarises evidence from child injury studies from the SEAR countries. The included papers reported varying estimates of overall non-fatal unintentional injury rates across the countries, from 15/1000 children in Thailand to as high as 342/1000 children in India. The fatal injury rates were also found to be varying. This review revealed a need for strengthening child injury research using standard methodologies across the region and for promoting the dissemination of the results. [ABSTRACT FROM PUBLISHER]

Background: Previous studies have presented conflicting results regarding the predictive effect of various clinical symptoms, signs, and plain imaging for intracranial pathology in children with minor head injury. Aims: To perform a meta-analysis of the literature in order to assess the significance of these factors and intracranial haemorrhage (ICH) in the paediatric population. Methods: The literature was searched using Medline, Embase, Experts, and the grey literature. Reference lists of major guidelines were crosschecked. Control or nested case-control studies of children with head injury who had skull radiography, recording of common symptoms and signs, and head computed tomography (CT) were selected. Outcome variable: CT presence or absence of ICH. Results: Sixteen papers were identified as satisfying criteria for inclusion in the meta-analysis, although not every paper contained data on every correlate. Available evidence gave pooled patient numbers from 1136 to 22 420. Skull fracture gave a relative risk ratio of 6.13 (95% CI 3.35 to 11 .2), headache 1 .02 (95% CI 0.62 to 1 .69), vomiting 0.88 (95% CI 0.67 to 1 .15), focal neurology 9.43 (2.89 to 30.8), seizures 2.82 (95% CI 0.89 to 9.00), LOC 2.23 (95% CI 1.20 to 4.16), and Glasgow Coma Scale (GCS) <15 of 5.51 (95% CI 1.59 to 19.0). Conclusions: There was a statistically significant correlation between intracranial haemorrhage and skull fracture, focal neurology, loss of consciousness, and GCS abnormality. Headache and vomiting were not found to be predictive and there was great variability in the predictive ability of seizures. More information is required about the current predictor variables so that more refined guidelines can be developed. Further research is currently underway by three large study groups. [ABSTRACT FROM AUTHOR]

In this paper, authors introduce the basic prerequisite for rational, targeted, and above all, child-oriented diagnosis of fractures and dislocations in children and adolescents is in-depth prior knowledge of the special features of trauma in the growth age group. This review summarizes the authors' many years of experience and the state of the current pediatric traumatology literature. It aims to provide recommendations for rational, child-specific diagnostics appropriate to the child, especially for the area of extremity injuries in the growth age. The plain radiograph remains the indispensable standard in diagnosing fractures and dislocations of the musculoskeletal system in childhood and adolescence. Plain radiographs in two planes are the norm, but in certain situations, one plane is sufficient. X-rays of the opposite side in acute diagnostics are obsolete. Images to show consolidation after conservative treatment is rarely necessary. Before metal removal, however, they are indispensable. The upcoming diagnostical tool in pediatric trauma is ultrasound. More and more studies show that in elected injuries and using standardized protocols, fracture ultrasound is as accurate as plain radiographs to detect and control osseous and articular injuries. In acute trauma, CT scans have only a few indications, especially in epiphyseal fractures in adolescents, such as transitional fractures of the distal tibia or coronal shear fractures of the distal humerus. CT protocols must be adapted to children and adolescents to minimize radiation exposure. MRI has no indication in the detection or understanding of acute fractures in infants and children. It has its place in articular injuries of the knee and shoulder to show damage to ligaments, cartilage, and other soft tissues. Furthermore, MRI is useful in cases of remaining pain after trauma without radiological proof of a fracture and in the visualization of premature closure of growth plates after trauma to plan therapy. Several everyday examples of rational diagnostic workflows, as the authors recommend them, are mentioned. The necessity of radiation protection must be taken into consideration. [ABSTRACT FROM AUTHOR]

Cervical trauma in children have variations from the adults mainly due to anatomic differences. An optimal diagnostic and treatment strategy is critical, particularly when there is a lack of standardized protocols for the management of such cases. This review paper examines the diagnostic and treatment options of pediatric cervical trauma and Spinal Cord Injury Without Radiographic Abnormality (SCIWORA). A literature search for the last 10 years were conducted using key words. Case reports, experimental studies, papers other than English language were excluded. Up-to-date information on pediatric cervical trauma and SCIWORA were reviewed and statements were produced to reach a consensus in 2 separate consensus meeting of WFNS Spine Committee. The statements were voted and reached a consensus using Delphi method. This review reflects different aspects of contemporary pediatric cervical trauma decision-making and treatment, and SCIWORA. The mainstay of SCIWORA treatment is nonsurgical with immobilization, avoidance of risky activities. Prognosis generally depends on the initial neurological status and magnetic resonance imaging. Due to a significant discrepancy in the literature on diagnostic and management, future randomized controlled trials are needed to aid in generating standardized protocols. [ABSTRACT FROM AUTHOR]

The author reflects on the identification of safeguarding practices against child abuse and the basis for them in the September 2009 issue. She discusses several reports published within the issue including one on the evidence for safeguarding practices by Marjorie Keys, a critique of the report "The Protection of Children in England: A Progress Report," by Jennifer Driscoll, and one on non-accidental injuries by Clare Onyon and colleagues.

OBJECTIVES: To critically synthesise current knowledge of the patterns of injuries and risk factors for injury in school-aged children, to summarise the evidence and support effective child injury prevention initiatives. DESIGN: Systematic review. SELECTION CRITERIA AND METHODS: Prospective cohort studies reporting unintentional injuries in healthy children aged 5–18 years were identified by searching 15 electronic databases and additional grey literature sources. A narrative synthesis was conducted of papers meeting quality criteria, with risk factors analysed at individual, family and environmental levels. Limitations of existing evidence were considered. RESULTS: 44 papers from 18 different cohort studies met the inclusion criteria. There were broad and consistent patterns of injury across time and place. Male sex, psychological, behavioural and risk-taking behaviour problems, having a large number of siblings, and a young mother were all associated with increased injury occurrence across more than one cohort and setting. CONCLUSIONS: Descriptive epidemiology and risk factors for injury were derived from prospective cohort studies, but few studies used the full potential of their design. Opportunities to use repeated measures to assess temporal changes in injury occurrence, and the exploration of risk factors, particularly those related to the child’s environment, have rarely been undertaken. Few studies were conducted in low/middle-income countries where the burden of injury is greatest. These findings should be considered when planning future research and prevention initiatives. [ABSTRACT FROM AUTHOR]

In order to explore the influence of the general layout parameters of the child restraint system on the evaluation index of child injury in a frontal impact, and to explore the general layout plan that can minimize the child's injury, this paper selects an I-Size child safety seat that meets the ECE R44 regulations as the research object, in accordance with the ECE R129 regulations, uses the Q3 child dummy to perform a frontal impact sled test on it, and record the test results. On this basis, a simulation concept model of the child safety seat is established, and the parameter combination of the seat back angle and cushion angle and the parameters of the five-point seat belt exit position are studied, and the overall layout design scheme with the best child protection performance is obtained. [ABSTRACT FROM AUTHOR]

Digital radiography is widely available and the standard modality in trauma imaging, often enabling to diagnose pediatric wrist fractures. However, image interpretation requires time-consuming specialized training. Due to astonishing progress in computer vision algorithms, automated fracture detection has become a topic of research interest. This paper presents the GRAZPEDWRI-DX dataset containing annotated pediatric trauma wrist radiographs of 6,091 patients, treated at the Department for Pediatric Surgery of the University Hospital Graz between 2008 and 2018. A total number of 10,643 studies (20,327 images) are made available, typically covering posteroanterior and lateral projections. The dataset is annotated with 74,459 image tags and features 67,771 labeled objects. We de-identified all radiographs and converted the DICOM pixel data to 16-Bit grayscale PNG images. The filenames and the accompanying text files provide basic patient information (age, sex). Several pediatric radiologists annotated dataset images by placing lines, bounding boxes, or polygons to mark pathologies like fractures or periosteal reactions. They also tagged general image characteristics. This dataset is publicly available to encourage computer vision research. Measurement(s) wrist fracture • pronator quadratus sign • AO classifiction • soft tissue swelling • metal implant • osteopenia • plaster cast • bone Lesion • subperiosteal bone formation Technology Type(s) bone radiography [ABSTRACT FROM AUTHOR]

Injury is a leading cause of morbidity and mortality among children in the USA. Understanding the impact of executive functions (EFs) on the risk of injuries is crucial for developing effective interventions. However, literature has failed to examine the relationship between multiple EFs and injury domains. The present paper quantitatively synthesized research on cool and hot EFs and children's intentional and unintentional injury risks using a novel meta-analytic structural equation modeling (MASEM) approach. A systematic review was conducted in the following databases: PsycINFO, Scopus, SafetyLit, Cochrane Central, and PubMed (Medline). After screening titles, abstracts, and full texts, a total of 31 studies were eligible for the MASEM analysis. One-stage MASEM was conducted on six conceptualized path analysis models according to the complexity of exogenous and endogenous variables. The MASEM models suggested that hot and cool EFs were negatively associated with children's risk of injury or injury-related risk behaviors regardless of mean age and proportion of females. Among cool EF skills, inhibitory control, but not working memory or cognitive flexibility, was significantly associated with risks of unintentional injuries. Emotion regulation was the dominant hot EF skill examined in the literature and was found significantly associated with risks of non-suicidal self-injuries (NSSIs). EF has a significant impact on children's risk of both unintentional and intentional injuries. Future research should focus on the combined force of hot and cool EF on children's risks of injuries and injury-related risk behaviors. [ABSTRACT FROM AUTHOR]

Background: Injuries are a leading cause of death and disabilities for children and youth globally. Measuring the health related quality of life of injured children and youth can help gain understanding of the impact of injuries on this population; however, psychometric evaluation of health related quality of life tools among this population is lacking. The purpose of this study was to determine the construct validity of the EQ-5D-3L™ for use among a population of injured young people and to examine the reliability of different modes of administration including paper and pencil, online and telephone. Methods: In total, 345 participants (aged 0 - 16) were recruited from a paediatric hospital in a large urban centre in British Columbia, Canada. To capture a variety of injury types and severity, patients were recruited from in-patient units and the emergency department. Data were collected at the time of recruitment and at one month post injury. Results: Repeated measures analysis (rANOVA) showed that EQ-5D-3L™ scores were different before and after injury and significant between group differences (Visual Analog Scale: F = 4.61, p = 0.011; Descriptive Scale: F = 29.58, p < 0.001), within group differences (Visual Analog Scale: F = 60.02, p < 0.001; Descriptive Scale: F = 92.37, p < 0.001), and interaction between variables (Visual Analog Scale: F = 10.89, p < 0.001; Descriptive Scale: F = 19.25, p < 0.001) were detected, indicating its suitability for assessment of post-injury health related quality of life. Bland-Altman plots confirmed that few differences existed between modes of administration. Conclusion: The EQ-5D-3L™ is an appropriate instrument for collecting health related quality of life data among injured children and can be administered via paper-pencil, online or by telephone. [ABSTRACT FROM AUTHOR]

Background: A pediatric trauma registry for the Kingdom of Bahrain would be a novel public health tool for the Bahraini health system. The aim of this study was to explore the epidemiology of pediatric trauma at the national level by describing the distribution of pediatric injury in the Kingdom, and quantifying the burden of injury shouldered by the study population. Methods: This multicenter observational cross-sectional study was conducted in Bahrain using data from the Pediatric Trauma Registry (PTR), which was a short-term paper-based prospective trauma registry that collected data over a three-month period in 2018. PTR was based in the pediatric emergency departments (ED) of the three national referral hospitals in the Kingdom. By simultaneously collecting data from all three trauma hospitals in the country, it was assumed that during the data collection period all major pediatric trauma patients in the country would be captured by the study, and that the data collected would provide national estimates of trauma. Inclusion criteria for the study was any individual under the age of 14, that arrived at the ED seeking care for intentional and unintentional injuries. Results: A total of 1328 patients were included in the study. Sixty-nine percent of patients were treated and discharged from the ED, 30.5% were admitted to the hospital, admitted for surgery, or seen by a specialist, and 0.5% were declared deceased. The percentage of patients documented as unrestrained during Motor Vehicle Collisions (MVC) was 92.3%, and amongst those involved in MVC, 12% were ejected from the cabin of the vehicle. Conclusions: There are significant implications that this study holds for policy implementation and practice surrounding injury prevention in the Kingdom of Bahrain. Low seatbelt utilization and the high proportion of ejection amongst MVC victims warrant immediate public health policy implementation, including enforcement of seat belt laws, strengthening of the traffic court system, and awareness campaigns for MVC prevention. Additionally, pediatric drowning prevention programs centered on constant adult supervision, pool isolation fencing, personal flotation devices, and swimming education should be created to address the mortality attributable to drowning in this study. [ABSTRACT FROM AUTHOR]

Purpose The aim of this paper is to describe our experience with a virtual fracture management pathway in the setting of a paediatric trauma service. Methods All patients referred to the virtual fracture clinic service from the Paediatric Emergency Department (PED) were prospectively collected. Outcome data of interest (patients discharged, referred for urgent operative treatment, referred back to emergency department for further evaluation, referred for face-to-face clinical assessment and all patients who re-presented on an unplanned basis for further management of the index injury) were compiled and collated. Cost analysis was performed using established costing for a virtual fracture clinic within the Irish Healthcare System. Results There were a total of 3961 patients referred to the virtual fracture clinic from the PED. Of these, 70% (n = 2776) were discharged. In all, 26% (n = 1033) were referred to a face-to-face appointment. Of discharged patients, 7.5% (n = 207) required an unplanned face-to-face evaluation. A total of 0.1% (n = 3) subsequently required operative treatment relating to their index injury. Implementation of the virtual fracture clinic model generated calculated savings of €254 120. Conclusion This prospective evaluation has demonstrated that a virtual fracture clinic pathway for minor paediatric trauma is safe, effective and brings significant cost savings. [ABSTRACT FROM AUTHOR]

Objective: A clival fracture is a rare but life-threatening traumatic brain injury in the adult and pediatric populations. To date, there are very few conclusive recommendations in the literature concerning the diagnosis and treatment of pediatric clival fractures. Methods: In 2014 and 2015, two pediatric patients with severe blunt head trauma and clival fractures were evaluated and treated at a level I trauma center. Both cases are documented and supplemented by an extensive review of the literature focusing on the diagnostic workup, classification, and clinical course of clival fractures in children. Results: The clinical course of two children (8 and 9 years old) with clival fractures in concert with other intra- and extracranial injuries was analyzed. A total of 17 papers encompassing 37 patients (age range, 1–18 years) were included for a systematic review. The literature review revealed a mortality rate of 23% in pediatric patients with a clival fracture. Over 50% of the patients presented with cranial nerve damage, and two-thirds suffered from intracranial vascular damage or intracerebral bleeding. Conclusions: Clival fractures are a very rare but severe consequence of blunt head trauma in the pediatric population and may be challenging to diagnose, especially in cases with an unfused sphenooccipital synchondrosis. Vascular damage following clival fractures appears to be as common in pediatric patients as in adults. Therefore, contrast-enhanced CT of the cervical spine and head and/or magnetic resonance angiography is strongly recommended to rule out vascular injury of the extra- and intracranial brain-supplying vessels within the trauma room setting. [ABSTRACT FROM AUTHOR]

The paper concentrates on the safety analysis of children transported in bicycle-mounted baby carriers. The biomechanics are widely researched for pedestrians and cyclists, but there is no clear understanding of children's kinematics during accidents in commonly used baby carriers. Using a finite element vehicle model coupled with a multibody bicycle, dummies and a generic baby carrier, the authors numerically simulated various impact scenarios. The results of the simulations proved a complex motion of the bicycle. Validation of the simulative outcome was done by comparison to full-scale tests from the literature. This includes Wrap Around Distances and cyclist kinematics as well as the frontal shape parameters of the impacting vehicle. Further, the crashworthiness of the baby carrier was investigated. It was concluded that the belt system, which is attached to the baby carrier, was in several cases not able to secure the child in its position. In a result, the studied baby carrier showed poor performance as a passive safety device during the simulated accidents. In this respect, also possible injuries of the child's head, brain and neck were discussed. Finally, the authors concluded that the kinematics of the impacted child buckled in a baby carrier are neither representing cyclist's nor pedestrian's kinematics. [ABSTRACT FROM AUTHOR]

Severely neglected and traumatised children have also suffered from a lack of the parental nurturing which is needed for ordinary emotional development to take place. Often their past experiences make them unable to utilise the nurturing that foster and adoptive families try to give them and they are delayed or stuck in their development. In therapy, when the early small signs of new emotional development start to emerge, they may be heralded by technical challenges to the therapist. Two examples are given in this paper, which are discussed in the context of Sternet al.’s ideas about moments of meeting, Winnicott’s concepts about transitional phenomena and playing, and Hurry and her colleagues’ thoughts about the therapist as a developmental object. It is argued that it is important for the therapist to be alert to the possible significance of these technical adaptations in terms of the child’s capacity for new emotional development. These often indicate that a watershed in the treatment has been reached and if positively responded to, that the patient is in the process of ‘putting down roots’ in the ground of the therapeutic relationship and starting to grow across a spectrum of developmental pathways. [ABSTRACT FROM AUTHOR]

Fall is one of the most critical accidents resulting in serious injuries and significant financial losses among people in all ages. This paper presents the application of full factorial design (FFD) to investigate fall detection algorithms that have multiple hyperparameters which are very difficult to identify the best values for the dataset. In this study, the algorithm factors are investigated from two motion sensors and six artifact neural network (ANN) parameters on seven possible outcomes of signal detection theory (SDT). It is found that only one accelerometer and one gyroscope and small size ANN with scaled conjugate gradient (SCG) and radial basis function (RBF) provide a higher performance classification with lower computational complexity. Experimental outcomes show the new method using statistical theory for the selection of the most effective performance of fall detection algorithm parameters. Findings from the current study could be applied to various types of classification model problems in engineering applications, such as the design of products and systems. [ABSTRACT FROM AUTHOR]

Duress is a defense in both law and morality. The bank teller who provides an armed robber with the bank vault combination, the innocent suspect who fabricates a story after hours of interrogation, the Good Samaritan who breaks into a private cabin in the woods to save a stranded hiker, and the father who drives at high speed to rush his injured child to the hospital—in deciding how to respond to agents like these, we should take into account that they have acted under duress. In this paper, I offer a new duress defense, which I call "distinctive duress." The distinctive-duress defense is neither ordinary justification nor ordinary excuse. Rather, it is a defense available to agents who act wrongly because they are appropriately insensitive to certain reasons. In the distinctive-duress cases, an agent's normative sensitivities are rightly directed elsewhere, leading them awry. [ABSTRACT FROM AUTHOR]

Thousands of children die each year as a result of unintentional injuries. Some of these deaths may be preventable. Given that there are different types of safety responses, a comprehensive review of the literature would provide information on important deficits and avenues for future research. The purpose of the present review was to evaluate the extant literature on procedures for teaching safety responses and provide suggestions and considerations for future research. Our review of the literature revealed that although many safety categories are well represented in the current literature, others still warrant investigation. Furthermore, there is a call for future researchers to provide a more systematic description of experimental procedures and participants in their papers to allow for future replications. Future research would also benefit from further evaluations into specific procedural modifications that will lead to better generalization of safety responses to naturalistic settings and long-term maintenance outcomes. [ABSTRACT FROM AUTHOR]

In the field of pediatric neurorehabilitation, there is a dearth of well-defined models of care for children with brain injuries and research to support them. Literature reviews of both adult and pediatric studies suggest that programs involving a comprehensive and holistic approach to care may be particularly effective in addressing the issues faced by individuals recovering from acquired brain injury. The primary purpose of this paper is to propose a model of holistic neurorehabilitation for children with an acquired brain injury, and to describe its theoretical bases. The paper describes such a program developed at Children's Specialized Hospital in New Jersey, USA, and presents a brief synopsis of the program's philosophy, components, goals, and therapeutic interventions. In addition, the paper discusses the type of data necessary to demonstrate the clinical utility and cost-effectiveness of such a program, and calls for future research to examine this. [ABSTRACT FROM AUTHOR]

Child injuries caused by unsafe climbing equipments has become a public concern. The Malaysian Standards for playground equipment (MS 966: 2001 and MS 966: 2017) was developed and reviewed periodically by the authority of the Consumer Products, Personal Safety and Services Industry Standards Committee, Department of Standards Malaysia (DSM) and SIRIM Berhad, as a means of protecting and benefiting the health and safety of children. This paper aims to examine and critique the applicability of Malaysian Standards on standardizing design specification and safety performance of climbing equipments. The review process focuses on information gaps within the Malaysian Standards in terms of feasibility, where discussions on analytical issues in Malaysian Standards of climbing equipment was presented and recommendations on improvement were proposed. The result showed the standards focused mostly on swings and slides, whilst three analytical issues found that important design and safety standards in climbing equipments were unclear; which included free fall height, maximum height and designated age group. These three analytical issues have to be revised in order to achieve sustainable design in climbing equipment. Results from this paper could assist in revising the current standards incorporated with advanced urban recreation safety for injury control. [ABSTRACT FROM AUTHOR]

Primary objective: The focus of this paper is to review the current literature on the use of amandatine in children who have sustained a head injury. Main outcomes and results: A MEDLINE search was conducted and yielded five papers. They were composed of prospective, retrospective and case study designs. Dosage use and side effect profiles were consistent with expected norms. Efficacy was measures primarily by alertness and arousal and positive results were found for all studies on these dimensions. Behavioural and cognitive measures of outcome yielded mixed results. Conclusions: The studies reviewed for this paper suggest that amantadine is clinically beneficial for children who have sustained head injuries. Double blind placebo controlled trials with larger sample sizes are needed to further substantiate these findings. [ABSTRACT FROM AUTHOR]

Objectives: To identify the risk of injury to young people participating in non-elite sport, and to establish whether the immediate ‘on-field’ medical care they receive is adequate. Methods: A literature search of electronic databases was initially undertaken, in addition to searches of governmental bodies' websites; papers obtained were then cross-referenced and appropriate articles ordered through interlibrary loans. Results: A total of 24 relevant papers were identified for review. Conclusions: The lack of standardised injury definitions and surveillance methods confounds the development of injury prevention strategies for young athletes. Future studies should be designed to measure injury exposure, so injury rates can be calculated which will make analysis and comparisons easier and more meaningful. Further studies investigating the extent of coaches', teachers' and therapists' first-aid knowledge and qualifications, and also the quality of the training they receive would also help to determine whether young athletes are receiving adequate ‘on-field’ care. [ABSTRACT FROM AUTHOR]

Discusses various pediatrics research published in different medical journals. "Wilms' tumour: past, present and (possibly) future," by F. Spreafico; "West Nile virus infection in the pediatric population," by R. Civen and colleagues; "Toddlers at risk for paper shredder injury in the home: easy access and severe injury," R. C. Warren.

This article introduces several papers in this special issue which deal with emotive topics that should arouse strong feelings toward the protection of infants. Babies are by nature dependent and vulnerable. Because of this they are prone to abuse, and the abuse they suffer may have particularly severe consequences. The term "baby rape" is also designed to shock. This captures the violence of abuse far more effectively than simply 'sexual abuse' or even 'penetrative sexual abuse.' In coining another emotive phrase, 'the battered child syndrome', it succeeded in generating outrage and bringing the issue of child abuse into the public and, perhaps more importantly, professional consciousness. Our understanding of the nature of both physical and other forms of child abuse has grown, and this in turn has led to policies and procedures designed to protect children. Introduction to the literature on shaken baby syndrome has been presented, which is a very useful starting point for anyone wanting an update on the vast amount of research on the topic. Subdural haemorrhage is providing one of the most robust population studies of this condition and has a potential to improve our understanding of the topic.

The authors discuss their concerns on an article that cites the term, temporary brittle bone disease (TBBD). They express their frustrations that TBBD has been proposed again as an alternative explanation for suspected non-accidental injury. They explain the papers that lead to the development of the term. They also request the journal editors to retract articles by the advocate of the term citing TBBD.

Thoracic blunt trauma is evident in up to one-fifth of all hospital admissions, and is second only to head trauma in motor vehicle crashes. One of the most problematic injury mechanisms associated with blunt thoracic trauma is pulmonary contusion, occurring in up to 75% of blunt thoracic trauma cases. The source and effects of pulmonary contusion caused by blunt lung injury are not well defined, especially within the field of continuum biomechanics. This, paired with unreliable diagnostics for pulmonary contusion, leads to uncertainty in both the clinical entity and mechanics of how to predict the presence of injury. There is a distinct need to combine the clinical aspects with mechanical insights through the identification and mitigation of blunt lung trauma and material testing and modeling. This is achieved through using the mechanical insights of lung tissue behavior in order to better understand the injurious mechanisms and courses of treatment of blunt-caused pulmonary contusion. This paper hopes to act as a step forward in connecting two perspectives of blunt lung injury, the clinical entity, and mechanical testing and modeling, by reviewing the known literature and identifying the unknowns within the two related fields. Through a review of related literature, clinical evidence is correlated to mechanical data to gain a better understanding of what is being missed in identification and response to blunt lung injury as a whole. [ABSTRACT FROM AUTHOR]

This paper addresses significant misconceptions regarding the etiology of fractures in infants and young children in cases of suspected child abuse. This consensus statement, supported by the Child Abuse Committee and endorsed by the Board of Directors of the Society for Pediatric Radiology, synthesizes the relevant scientific data distinguishing clinical, radiologic and laboratory findings of metabolic disease from findings in abusive injury. This paper discusses medically established epidemiology and etiologies of childhood fractures in infants and young children. The authors also review the body of evidence on the role of vitamin D in bone health and the relationship between vitamin D and fractures. Finally, the authors discuss how courts should properly assess, use, and limit medical evidence and medical opinion testimony in criminal and civil child abuse cases to accomplish optimal care and protection of the children in these cases. [ABSTRACT FROM AUTHOR]

This paper examines the construct of countertransference and its role in the treatment of a traumatized child, with emphasis on the perspective of a psychology trainee. A review of the countertransference literature is provided and then multiple aspects of the phenomenon are explored within the context of psychotherapy with one 11-year-old boy who was a victim of trauma. The relevance of three specific countertransference roles—rescuer, abuser, and victim—is depicted through an in-depth account of psychotherapy sessions with the child. The paper emphasizes the underlying challenges associated with taking on these three countertransference roles as a nascent and curious trainee. [ABSTRACT FROM PUBLISHER]

Burns are a significant cause of morbidity and mortality in children. While the majority of pediatric burns are not life-threatening, they can have a significant impact on a child's physical and psychological health. They pose a major social and financial burden, particularly in developing countries. The management of pediatric patients with thermal injuries requires a complex and multifaceted approach. Pediatric burns constitute approximately 40-50% of all reported cases of severe burns. The most common etiologies of pediatric burns include scalds, contact burns, flames, and chemicals. From 80% to 90% of burns occurred at home and were accidental. Despite advancements in treatment, severe burns can lead to life-threatening complications, such as sepsis, multisystem organ failure, and hypermetabolic response or even death. This article aims to provide a literature-based overview of pediatric burn trauma, outlining its unique characteristics, etiology, epidemiology, classification, and initial management. [ABSTRACT FROM AUTHOR]

The Covid‐19 pandemic resulted in unprecedented restrictions on many public, private, and workplace activities throughout the United States and elsewhere. When restrictions were imposed, we were conducting a type III hybrid effectiveness‐implementation trial in 10 pediatric trauma centers. In response to several pandemic‐based restrictions, we had to develop procedures for engaging with potential research participants while limiting nonclinical, in‐person interactions. This manuscript describes the procedures and challenges of obtaining electronic informed consent and assent in a multisite trauma center‐based research study. We developed, tested, and trained staff to implement three options for obtaining informed consent. Twenty‐five participants were enrolled in the effectiveness‐implementation multisite trial during the first six months of utilization of the consent options, with eleven of these individuals enrolled using hybrid or electronic consent procedures. The challenges we identified involving electronic consent procedures included confusion over who would complete the electronic consent process and difficulties reconnecting with families. Lessons learned can strengthen electronic consent and assent procedures for future studies. More research is needed to further strengthen this process and increase its utilization. [ABSTRACT FROM AUTHOR]

Purpose: New guidelines have been proposed for venous thromboembolism (VTE) prophylaxis in pediatric trauma patients. This paper seeks to evaluate risk factors associated with VTE that might further guide patient selection for prophylaxis.Methods: Review of a tertiary children's academic hospital's trauma database for VTE events and associated risk factors from 2005 to 2016.Results: 15,306 pediatric trauma patients were identified and reviewed. During this time period there were 6191 admissions (40.4%), of which 20 developed a VTE (0.3%) including two pulmonary emboli. Primary outcome was comparison of risk factors for developing a VTE that were identified in the literature. Age stratification revealed the highest incidence of VTE in children under the age of 2 (0.7%), which increased with CVC placement when compared to children aged 2-12 and 13-15 (0.036 Fisher's exact test).Conclusions: VTE after pediatric trauma is rare, and may be more uncommon than previously reported. CVC placement was the strongest predictor of VTE, particularly in infant and toddler patients which can explain their higher overall incidence compared to other pediatric age groups. Identifying high-risk patients is important to optimize screening and prophylaxis of VTE in pediatric trauma patients while minimizing risks of anticoagulation. [ABSTRACT FROM AUTHOR]

Background: Pediatric traumatic brain injury (TBI) affects about 475,000 children in the United States annually. Studies from the 1990s showed worse mortality in pediatric TBI patients not transferred to a pediatric trauma center (PTC), but did not examine mild pediatric TBI. Evidence-based guidelines used to identify children with clinically insignificant TBI who do not require head CT were developed by the Pediatric Emergency Care Applied Research Network (PECARN). However, which patients can be safely observed at a non-PTC is not directly addressed.Methods: A systematic review of the literature was conducted, focusing on management of pediatric TBI and transfer decisions from 1990 to 2020.Results: Pediatric TBI patients make up a great majority of preventable transfers and admissions, and comprise a significant portion of avoidable costs to the health care system. Majority of mild TBI patients admitted to a PTC following transfer do not require ICU care, surgical intervention, or additional imaging. Studies have shown that as high as 83% of mild pediatric TBI patients are discharged within 24 hrs.Conclusions: An evidence-based clinical practice algorithm was derived through synthesis of the data reviewed to guide transfer decision. The papers discussed in our systematic review largely concluded that transfer and admission was unnecessary and costly in pediatric patients with mild TBI who met the following criteria: blunt, no concern for NAT, low risk on PECARN assessment, or intermediate risk on PECARN with negative imaging or imaging with either isolated, nondisplaced skull fractures without ICH and/or EDH, or SDH <0.3 cm with no midline shift. [ABSTRACT FROM AUTHOR]

Among 1-19-year olds, unintentional injuries accounted for 12% of 5.1 million global deaths from injuries in 2010. Despite this high burden, childhood injuries have not received much attention in global health. This paper describes the major causes of deaths from childhood unintentional injuries and provides a review of interventions for reducing this burden. About 627 741 deaths were due to unintentional injuries in 2010 among 1-19-year olds. The proportionate mortality increased with age--from 12.6% among 1-4-year olds to 28.8% among 15-19-year olds. Deaths from Western sub-Saharan Africa and South Asia accounted for more than 50% of all deaths. Rates in these regions are 68.0 and 36.4 per 100 000 population, respectively, compared to 6.4 in Western Europe. Road traffic injuries (RTI) are the commonest cause of death, followed by deaths from drowning, burns and falls. Male children are more predisposed to unintentional injuries except for burns which occur more frequently among females in low and middle income countries (LMICs). Effective solutions exist--including barriers for preventing drowning; safer stoves for burns; child restraint systems for RTI--but the effectiveness of these measures need to be rigorously tested in LMICs. The general lack of a coordinated global response to the burden of childhood unintentional injuries is of concern. The global community must create stronger coalitions and national or local plans for action. Death rates for this paper may have been underestimated, and there is need for longitudinal studies to accurately measure the impact of injuries in LMICs. [ABSTRACT FROM AUTHOR]

Unintentional child injury is a significant public health concern and leading cause of death among children. Though the majority of unintentional injuries are preventable, few interventions target child injury hazards. Since many unintentional injuries occur in the home, home visiting may be an effective method for modifying unsafe home environments. In this paper, we examined whether a behavioral parenting program conducted in the home would reduce home safety hazards among families who were in the child welfare system or at risk for child maltreatment. Paired t-tests were used to analyze the change in number of safety hazards, as measured by the Home Accident Prevention Inventory-Revised, across four types of rooms. Significant reductions in home hazards were demonstrated across room type after program participation. Results suggest that families at risk for child maltreatment can have significant reductions in home safety hazards following program participation. [ABSTRACT FROM AUTHOR]

Background: Inadequate clinical experience still causes uncertainty in the acute diagnostic evaluation and treatment of polytrauma in children (with or without coagulopathy). This review deals with the main aspects of the acute care of severely injured children in the light of current guidelines and other relevant literature, in particular airway control, volume and coagulation management, acute diagnostic imaging, and blood coagulation studies in the shock room. Methods: This review is based on literature retrieved by a selective search in PubMed, Medline (OVIDSP), the Cochrane Central Register of Controlled Trials, and Epistemonikos covering the period January 2001 to August 2023. Review articles and the updated S2k clinical practice guideline on polytrauma management in childhood were considered. Results: Most accidents in childhood occur at home and in the child's free time, with varying mechanisms and patterns of injury depending on age. The outcome of treatment depends largely on the presence or absence or traumatic brain injury, which affects 66% of children with polytrauma and is thus the most common type of injury in this group, and of hemorrhagic shock with or without coagulopathy. Acute care follows the ABCDE algorithms with attention to special features in children, including age-specific reference values. According to a registry study, coagulopathy and hypovolemic shock are associated with 22% and 17% mortality, respectively. Treatment in a pediatric trauma reference center of the trauma network is recommended. Computed tomography (CT) should be carried out in children in accordance with defined criteria (PECARN), as a team decision and with the use of age-specific low-dose CT protocols. In children as in adults, viscoelasticity-based point-of-care tests enable the prompt diagnosis of relevant coagulopathies and their treatment in consideration of age-specific target values. The administration of tranexamic acid remains controversial. Conclusion: 4% of polytrauma patients are children. Because children differ from adults both anatomically and physiologically, the diagnostic evaluation and management of polytrauma in children presents a special challenge. The evidence base for pediatric polytrauma management is still inadequate; current recommendations are based on consensus, in consideration of the special features of children compared to adults. [ABSTRACT FROM AUTHOR]

Background: Chronic myocardial injury is a condition defined by stably elevated cardiac biomarkers without acute myocardial ischemia. Although studies from high-income countries have reported that chronic myocardial injury predicts adverse prognosis, there are no published data about the condition in sub-Saharan Africa. Methods: Between November 2020 and January 2023, adult patients with chest pain or shortness of breath were recruited from an emergency department in Moshi, Tanzania. Medical history and point-of-care troponin T (cTnT) assays were obtained from participants; those whose initial and three-hour repeat cTnT values were abnormally elevated but within 11% of each other were defined as having chronic myocardial injury. Mortality was assessed thirty days following enrollment. Results: Of 568 enrolled participants, 81 (14.3%) had chronic myocardial injury, 73 (12.9%) had acute myocardial injury, and 412 (72.5%) had undetectable cTnT values. Of participants with chronic myocardial injury, the mean (± sd) age was 61.5 (± 17.2) years, and the most common comorbidities were CKD (n = 65, 80%) and hypertension (n = 60, 74%). After adjusting for CKD, thirty-day mortality rates (38% vs. 36%, aOR 1.03, 95% CI: 0.52–2.03, p = 0.931) were similar between participants with chronic myocardial injury and those with acute myocardial injury, but significantly greater (38% vs. 13.6%, aOR 3.63, 95% CI: 1.98–6.65, p<0.001) among participants with chronic myocardial injury than those with undetectable cTnT values. Conclusion: In Tanzania, chronic myocardial injury is a poor prognostic indicator associated with high risk of short-term mortality. Clinicians practicing in this region should triage patients with stably elevated cTn levels in light of their increased risk. [ABSTRACT FROM AUTHOR]

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Background: Population aging is accelerating, particularly in Asian countries. Falls are the leading cause of unintentional injuries in the elderly over 60 years old in China. Hence, it is crucial to anticipate the risk factors associated with fall risk. We aimed to explore whether oral frailty and fall risk were reciprocally related and whether nutrition mediated their association. Methods: From October 2022 to March 2023, a total of 409 elderly individuals from the Yangzhou community were selected using the convenience sampling method. Cross-sectional data on older adults' oral frailty, nutrition, and fall risk were collected using questionnaires. Data analysis was performed using SPSS 27.0 and PROCESS macro. Results: The fall risk score was 1.0 (ranging from 0 to 4.0), with 107 cases (26.2%) identified as being at risk of falling. Spearman correlation analysis revealed a positive correlation between oral frailty and the risk of falls (rs = 0.430, P < 0.01). Nutrition was found to have a negative correlation with both oral frailty and fall risk (rs=-0.519、-0.457, P < 0.01). When controlling for covariates, it was observed that nutrition mediated the relationship between oral frailty and falls. The mediating effect value accounted for 48.8% of the total effect (P < 0.01). Conclusions: Oral frailty was significantly associated with fall risk, and nutrition might be a mediating factor for adverse effects of oral frailty and fall risk. Enhancing the nutrition of older individuals is a vital approach to mitigating fall risk among those with oral frailty. [ABSTRACT FROM AUTHOR]

3D SHINKEI neurography is a new sequence for imaging the peripheral nerves. The study aims at assessing traumatic brachial plexus injury using this sequence. Fifty-eight patients with suspected trauma induced brachial plexus injury underwent MR neurography (MRN) imaging in 3D SHINKEI sequence at 3 T. Surgery and intraoperative somatosensory evoked potentials or clinical follow-up results were used as the reference standard. MRN, surgery and electromyography (EMG) findings were recorded at four levels of the brachial plexus-roots, trunks, cords and branches. Fifty-eight patients had pre- or postganglionic injury. The C5–C6 nerve postganglionic segment was the most common (average 42%) among the postganglionic injuries detected by 3D SHINKEI MRN. The diagnostic accuracy (83.75%) and the specificity (90.30%) of MRN higher than that of EMG (p < 0.001). There was no significant difference in the diagnostic sensitivity of MRN compared with EMG (p > 0.05). Eighteen patients with brachial plexus injury underwent surgical exploration after MRN examination and the correlation between MRN and surgery was 66.7%. Due to the high diagnostic accuracy and specificity, 3D SHINKEI MRN can comprehensively display the traumatic brachial plexus injury. This sequence has great potential in the accurate diagnosis of traumatic brachial plexus injury. [ABSTRACT FROM AUTHOR]

This cohort study uses patient data from the Medicaid and Children's Health Insurance Program to investigate if antipsychotic treatment of children and young adults without severe somatic illness or psychosis is associated with increased risk of death. Key Points: Question: Is antipsychotic treatment of children and young adults without severe somatic illness or psychosis associated with increased risk of death? Findings: In a cohort of 2 067 507 Medicaid patients aged 5 to 24 years, antipsychotic treatment was associated with increased risk of death only for patients with doses greater than 100-mg chlorpromazine equivalents. Risk was not significantly associated with lower doses or with either dose in children aged 5 to 17 years. Meaning: Antipsychotic treatment of 100-mg chlorpromazine equivalents or less or in children was not associated with increased mortality; further research is needed to better understand the increased risk of death with higher doses in young adults. Importance: Dose-related effects of antipsychotic medications may increase mortality in children and young adults. Objective: To compare mortality for patients aged 5 to 24 years beginning treatment with antipsychotic vs control psychiatric medications. Design, Setting, and Participants: This was a US national retrospective cohort study of Medicaid patients with no severe somatic illness or schizophrenia or related psychoses who initiated study medication treatment. Study data were analyzed from November 2022 to September 2023. Exposures: Current use of second-generation antipsychotic agents in daily doses of less than or equal to 100-mg chlorpromazine equivalents or greater than 100-mg chlorpromazine equivalents vs that for control medications (α agonists, atomoxetine, antidepressants, and mood stabilizers). Main Outcome and Measures: Total mortality, classified by underlying cause of death. Rate differences (RDs) and hazard ratios (HRs) adjusted for potential confounders with propensity score–based overlap weights. Results: The 2 067 507 patients (mean [SD] age, 13.1 [5.3] years; 1 060 194 male [51.3%]) beginning study medication treatment filled 21 749 825 prescriptions during follow-up with 5 415 054 for antipsychotic doses of 100 mg or less, 2 813 796 for doses greater than 100 mg, and 13 520 975 for control medications. Mortality was not associated with antipsychotic doses of 100 mg or less (RD, 3.3; 95% CI, −5.1 to 11.7 per 100 000 person-years; HR, 1.08; 95% CI, 0.89-1.32) but was associated with doses greater than 100 mg (RD, 22.4; 95% CI, 6.6-38.2; HR, 1.37; 95% CI, 1.11-1.70). For higher doses, antipsychotic treatment was significantly associated with overdose deaths (RD, 8.3; 95% CI, 0-16.6; HR, 1.57; 95% CI, 1.02-2.42) and other unintentional injury deaths (RD, 12.3; 95% CI, 2.4-22.2; HR, 1.57; 95% CI, 1.12-2.22) but was not associated with nonoverdose suicide deaths or cardiovascular/metabolic deaths. Mortality for children aged 5 to 17 years was not significantly associated with either antipsychotic dose, whereas young adults aged 18 to 24 years had increased risk for doses greater than 100 mg (RD, 127.5; 95% CI, 44.8-210.2; HR, 1.68; 95% CI, 1.23-2.29). Conclusions and Relevance: In this cohort study of more than 2 million children and young adults without severe somatic disease or diagnosed psychosis, antipsychotic treatment in doses of 100 mg or less of chlorpromazine equivalents or in children aged 5 to 17 years was not associated with increased risk of death. For doses greater than 100 mg, young adults aged 18 to 24 years had significantly increased risk of death, with 127.5 additional deaths per 100 000 person-years. [ABSTRACT FROM AUTHOR]

Purpose – This paper aims to outline the duties placed upon public bodies towards children with acquired brain injuries. Design/methodology/approach – The paper outlines the key obligations owed to such children by local authority children's services and health bodies, dealing with the responsibilities of each and the duty to co-operate placed on them. It also discusses the avenues of redress open to families of children with brain injuries and the various ways they can ensure that public bodies comply with their obligations. Findings – The article summarises relevant law and avenues of redress that may be used where duties are not complied with. Originality/value – The paper provides an up-to-date summary of the relevant duties which includes reference to applicable case law and focuses particularly on how the law applies to children with acquired brain injuries. [ABSTRACT FROM AUTHOR]