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Objective: We evaluated the moderating effect of preinjury psychosocial function on postconcussion symptoms for children with mild traumatic brain injury (mTBI). Design, Setting, and Population: We conducted a prospective cohort study of children ages 8.0 to 16.9 years with mTBI (n = 633) or orthopedic injury (OI; n = 334), recruited from 5 pediatric emergency departments from September 2016 to December 2018. Main Measures: Participants completed baseline assessments within 48 hours of injury, and postconcussion symptoms assessments at 7 to 10 days, weekly to 3 months, and biweekly to 6 months post-injury. Preinjury psychosocial function was measured using parent ratings on the Pediatric Quality of Life Inventory (PedsQL) and the Strengths and Difficulties Questionnaire (SDQ), retrospectively evaluating their child's status prior to the injury. Parent and child ratings on the Health and Behavior Inventory (HBI) (cognitive and somatic subscales) and the Post-Concussion Symptom Interview (PCS-I) were used as measures of postconcussion symptoms. We fitted 6 longitudinal regression models, which included 747 to 764 participants, to evaluate potential interactions between preinjury psychosocial function and injury group as predictors of child- and parent-reported postconcussion symptoms. Results: Preinjury psychosocial function moderated group differences in postconcussion symptoms across the first 6 months post-injury. Higher emotional and conduct problems were significantly associated with more severe postconcussion symptoms among children with mTBI compared with OI. Wald's χ2 for interaction terms (injury group × SDQ subscales) ranged from 6.3 to 10.6 (P values <.001 to.043) across parent- and child-reported models. In contrast, larger group differences (mTBI > OI) in postconcussion symptoms were associated with milder hyperactivity (Wald's χ2: 15.3-43.0, all P <.001), milder peer problems (Wald's χ2: 11.51, P =.003), and higher social functioning (Wald's χ2: 12.435, P =.002). Conclusions: Preinjury psychosocial function moderates postconcussion symptoms in pediatric mTBI, highlighting the importance of assessing preinjury psychosocial function in children with mTBI. [ABSTRACT FROM AUTHOR]

Objectives: To investigate sleep and its predictors in preschoolers with mild traumatic brain injury (mTBI). Participants and procedure: The sample included 225 children, aged 18 to 60 months, divided into 3 groups: children with accidental mTBI (n = 85), children with orthopedic injury (n = 58), and typically developing children (n = 82). Retrospective reports of preinjury sleep and family functioning were obtained as part of a baseline assessment at the time of recruitment. Parental ratings of sleep problems were collected 6 months postinjury on the full sample, and actigraphy data were collected on a subset of children. Demographic, preinjury, and periinjury factors were examined as potential predictors of sleep outcomes. Results: No group differences were found in ratings of sleep problems or for nighttime sleep duration and sleep efficiency, as measured by actigraphy. Besides, preexisting sleep disturbances and brain injury resulting in alteration of consciousness were identified as predictors of poorer sleep in the mTBI group. Conclusion: Although mTBI did not result in group-level sleep disturbances 6 months postinjury, the findings suggest that premorbid and injury-related factors place some children at risk for poorer sleep after mTBI. These factors should be documented so clinicians can intervene early. [ABSTRACT FROM AUTHOR]

Abstract: In children, many psychometric properties of the visual analogue scale (VAS) are known, including the minimum clinically significant difference (10mm on a 100-mm VAS). However, its imprecision or reliability is not well known. Thus, in order to determine the reliability of this scale, a prospective cohort study was performed in patients aged 8–17years presenting to a pediatric emergency department with acute pain. Pain was graded 4 times using a paper VAS (0–100mm): T0, T3, T6, and T⩾36 minutes. After T6, patients were asked if their pain had changed since T0 minute. The primary analysis was the repeatability coefficient of the VAS, determined according to the Bland-Altman method for measuring agreement using repeated measures in patients reporting that their pain was the same for T0, T3, and T6. In order to appropriately estimate the within-subject SD, 96 patients were required if we obtained 3 measurements for each patient. A total of 151 patients with a mean age of 12.2±2.5years were enrolled. Among them, 100 mentioned that their pain was the same for T0, T3, and T6 minutes. The repeatability coefficient of the VAS for these children was 12mm when the pain did not change. This implies that, for a child, all pain intensity measurements within 12mm should be considered the same pain intensity on a paper VAS. This measure should also be evaluated on other types of VAS. [Copyright &y& Elsevier]

The article presents a study on the association between sport injuries and consolidation of physical activity in children in the U.S. It states that there are 30 million children and teenagers who are registered in organized sport programs which resulted to about 3 million sport-related injuries. It explores the implicated factors that have been associated with sports injuries. The study reveals that there is a small association between risk factor of injury and amount of organized sport in the 7 days prior, however, it fails to disclose any association for the 48 hours prior to injury. It recommends further prospective studies with follow-up of multiple athletes in different sports to determine whether concentrating physical activity leads to more injury in children.

Objective: This study aimed to assess the impact of physicians' gender, work experience, and training on hospitalization among children visiting a pediatric emergency department (ED)., Methods: This retrospective cohort study used the computerized database of a tertiary care pediatric ED staffed by pediatric emergency physicians, general pediatricians, and general emergency physicians. Participants were all children evaluated in the ED between April 1, 2008, and March 31, 2009. The primary outcome was hospitalization, and secondary outcome was unscheduled return in the 48 hours after discharge from the ED. Determinants of outcomes were physician's gender, experience, and specialty training. Multivariate logistic regression was used to evaluate associations between physicians' characteristics and the risk of admission, adjusting for referral status, triage level, chief complaints, and other potential risk factors., Results: Forty-five physicians evaluated 49,146 patients during the study period. Physicians' individual admission and return rates varied from 1% to 24% and 0% to 11%, respectively. On multiple logistic regression, physician's gender was not a predictor of admission but the physician's years of experience was slightly associated with both admission rates and unscheduled return visits. As a group, pediatric emergency physicians demonstrated a lower admission rate than physicians trained in general pediatric or general emergency medicine., Conclusions: Individual physician's admissions proportions vary widely. Providers' experience and specialization in pediatric emergency medicine are weak predictors of admission, whereas gender was not associated.