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Objective: The purpose was to examine clinical profiles in concussed children aged 5–9 and 10–12 years and compare them with those of adolescents >12 years. Methods: This study included patients aged 5–18 years presenting to a specialty care concussion program with a sports- and recreation-related (SRR) concussion ≤28 days postinjury. Demographics, injury mechanisms, symptoms, and clinical features were assessed. Chi-squared tests, one-way ANOVA, and Kruskal-Wallis were used for comparisons across age groups. Results: A total of 3280 patients with SRR concussion were included: 5.0% were 5–9 years, 18.4% were 10–12 years, and 76.6% were 13–18 years. Younger age groups had more males than females (5–9 years: 70.7% vs. 29.3%) and more commonly sustained their injury during limited- (28.7%), and non-contact (7.9%) activities compared to other age groups (p < 0.01). Younger children presented less symptoms frequently (p ≤ 0.042), but higher symptom severity in somatic and emotional domains (p ≤ 0.016). Fewer 5–9-year-olds reported changes in school (25.6%), sleep (46.3%), and daily habits (40.9%) than adolescents (p < 0.001). Conclusions: Among SRR-concussed children and adolescents, we found significant age-related variations in demographics, injury mechanism, symptoms, and clinical features. Recognizing these unique features in younger children may facilitate targeted management and treatment. [ABSTRACT FROM AUTHOR]

Objective: To determine the relationship between patient characteristics and performance on the visio-vestibular examination (VVE) in a cohort of healthy youth athletes and explore the potential association between the VVE and other standardized concussion batteries. Design: Cross-sectional. Setting: Suburban middle and high school. Patients: One hundred ninety subjects age 11 to 18 enrolled before their respective scholastic sport season between August 2017 and March 2020. Assessment of Independent Variables: Patient age, sex, concussion history, comorbidities, hours of weekly exercise, Sport Concussion Assessment Tool, 5th edition (SCAT-5), King–Devick (K–D), Postconcussion Symptom Inventory (PCSI). Main Outcome Measures: Visio-vestibular examination abnormalities (smooth pursuit, horizontal and vertical saccades, horizontal and vertical gaze stability, convergence, right and left monocular accommodation, complex tandem gait). Results: Overall, 29.5% of subjects had at least one of 9 VVE elements abnormal, 7.9% at least 2, and 3.2% at least 3. None of 72 comparisons of the VVE elements, when stratified by age, sex, concussion history, history of headaches, attention deficit hyperactivity disorder, learning issues, psychiatric problems, motion sickness, or weekly hours of exercise, reached significance using the Benjamini–Hochberg procedure at a false discovery rate of 5%. There were no significant associations between VVE elements and the SCAT-5, K–D, or PCSI. Conclusions: The VVE is robust across multiple patient characteristics. Although healthy subjects may have one abnormal element, multiple abnormal elements are a less common feature, making multiple abnormal elements more indicative of concussion, highlighting the use of this assessment in the setting of injury. The VVE tests unique domains when compared with the PCSI, SCAT-5, and K–D. [ABSTRACT FROM AUTHOR]

Objective: To determine the proportion of non-concussed, neurologically normal children with failures on a vestibular and oculomotor examination for concussion performed in an acute setting. Design: This was a cross-sectional study of subjects 6-18 years old presenting to a paediatric emergency department with non-neurologic chief complaints. The examination was administered by a paediatric emergency medicine physician, and includes assessments of dysmetria, nystagmus, smooth pursuits, saccades, gaze stability, near-point of convergence, and gait/balance testing. Results: Of the 295 subjects enrolled, 24% failed at least one element of testing. About 13% had >1 failed element and 5% had >2 failed elements. About 29% of females and 19% of males had failed examinations. By age, 15% of subjects 6-8 years old, 32% 9-11 years, 32% 12-14 years, and 26% 15-18 years had failed examinations. Overall, 10% were unable to complete the exam due to developmental age. Conclusions: The provider should be aware that a proportion of non-concussed children may demonstrate failure on a single element of the vestibular and oculomotor exam. While this testing is of benefit to the acute care provider in diagnosing paediatric concussion, its utility is greatest in the context of an injury history with acute onset of concussion symptoms. [ABSTRACT FROM AUTHOR]

Objective: To estimate the direct costs of pediatric postconcussive syndrome (PCS). Design: Retrospective cohort study. Setting: Subspecialty sports medicine clinics of a large pediatric tertiary care network in the United States. Patients: One hundred fifty-four patients aged 5 to 18 years with PCS, evaluated between 2010 and 2011. Assessment of independent variables: Direct costs included visits to sports medicine clinic, visio-vestibular therapy, homebound education, subspecialist referral, and prescription-only medications (amantadine and amitriptyline), all measured beginning at 28 days after injury. Main outcome measures: Postconcussive syndrome was defined as persistence beyond 28 days from injury. Results: The cost incurred by each PCS patient for sports medicine visits was $1575, for visio-vestibular therapy was $985, for homebound tutoring was $55, for prescription medications was $22, and for subspecialist referral was $120, totaling $3557 per patient, with a 95% confidence interval range of $2886 to $4257. Conclusions: Given the high economic costs of PCS determined in this study, therapies that mitigate this syndrome may have the potential to be cost-effective and even cost saving. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVES: Fatal poisoning is a preventable cause of death among young children. Understanding factors surrounding these deaths will inform future prevention efforts. Our objective was to describe the characteristics of fatal pediatric poisonings using child death review data. METHODS: We acquired data from 40 states participating in the National Fatality Review-Case Reporting System on deaths attributed to poisonings among children aged ≤5 years from 2005 to 2018. We analyzed select demographic, supervisor, death investigation, and substance-related variables using descriptive statistics. RESULTS: During the study period, 731 poisoning-related fatalities were reported by child death reviews to the National Fatality Review-Case Reporting System. Over two-fifths (42.1%, 308 of 731) occurred among infants aged <1 year, and most fatalities (65.1%, 444 of 682) occurred in the child's home. One-sixth of children (97 of 581) had an open child protective services case at time of death. Nearly one-third (32.2%, 203 of 631) of children were supervised by an individual other than the biological parent. Opioids (47.3%, 346 of 731) were the most common substance contributing to death, followed by over-the-counter pain, cold, and allergy medications (14.8%, 108 of 731). Opioids accounted for 24.1% (7 of 29) of the substances contributing to deaths in 2005 compared with 52.2% (24 of 46) in 2018. CONCLUSIONS: Opioids were the most common substances contributing to fatal poisonings among young children. Over-the-counter medications continue to account for pediatric fatalities even after regulatory changes. These data highlight the importance of tailored prevention measures to further reduce fatal child poisonings. [ABSTRACT FROM AUTHOR]