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PURPOSE: Watercraft-associated trauma (WAT) in children has received little attention so far, despite the potentially severe and debilitating resulting injuries. The aim of this study was to evaluate all cases of major watercraft-associated trauma admitted to the Children's of Alabama during the past 10 years, identify patterns in mechanism and injury, and propose future prevention strategies. METHODS: We reviewed our (prospective) database for children admitted through our trauma center after major WAT. Charts were abstracted for mechanism, epidemiologic data, injury type and injury severity scale (ISS), as well as outcome. RESULTS: We identified 15 children (6 males, 9 females, age range 7 to 15, mean 12±2 years), involved in 14 accidents. Sharp trauma was inflicted by a propeller (n=4) or a rope (n=1). Towed tubing (riding an inflatable tube while being pulled by a boat) was the most prevalent mechanism (n=6). There was a trend towards higher ISS after towed tubing (24.8±12.4) compared to all other mechanisms (15.1±7.7). Mean length of stay was longer after towed tubing accidents (14.2±7.2 versus 4.9±3.4 days). All patients survived and eventually were discharged home. In one of the incidences, involving 2 victims of this series, the driver of the boat was intoxicated with alcohol. CONCLUSIONS: Pediatric watercraft-related accidents are infrequent, but often result in major injuries. More awareness for safety measures to prevent these injuries is warranted. Alcohol is not a major factor in pediatric watercraft-associated trauma. Tubes towed by a boat seem to be particularly dangerous, perhaps because of the rider's limited maneuverability and the fact that centrifugal force lets the tube travel well outside the wake in curves. Limiting boat speed and the use of protective gear on towed tubes when children are involved may decrease the incidence and severity of pediatric WAT. Language: en

BACKGROUND: The objective was to investigate the relationship of high gun ownership and gun death rate on children and determine predictors influencing the incidence and outcome of pediatric firearm injuries in a major pediatric level 1 trauma center. METHODS: We performed a retrospective review of our trauma registry to identify hospital admissions between April 1999 and March 2010. We extracted demographic and geographic data, seasonal variation, injury type, firearm type, and outcome. RESULTS: We identified 194 firearm injuries. The incidence did not change during the past decade. Most occurred during the second half of the year (61.4%). Mean age was 12.2 ± 4.6 years (range, 0.4-19.2 years). Unintentional shootings accounted for 100 injuries followed by assaults (n = 55) and innocent bystanders (n = 39). African American children were most often injured because of a violent cause (60.3%), whereas white children were shot unintentionally (80.1%). Powder-propelled firearms caused 82.5% of injuries. Overall, 17.5% of children required an operation, and 9.3% died. CONCLUSIONS: The overwhelming majority of children were injured after a gun went off unintentionally, whereas most African American children were shot violently. We identified certain seasonal and geographic clusters. These data can be used to target gun injury prevention programs. Language: en

Background: Anecdotally, laparoscopy has been used for the diagnosis and therapy of pediatric abdominal trauma, but only few studies have been published. We performed a systematic analysis of our experience concerning indications, procedures, and outcomes using laparoscopy in pediatric abdominal trauma patients. Methods: Our trauma database was searched for patients who underwent laparoscopy after being admitted for abdominal trauma. Cases were grouped into diagnostic and therapeutic procedures. Success was defined as attaining the correct diagnosis or as the ability to repair the injury by laparoscopy. Results: Of 4,836 pediatric trauma admissions over a period of 12 years, 92 had open or laparoscopic abdominal explorations for blunt (n = 47) and penetrating (n = 35) injuries. In 21 patients, diagnostic laparoscopic procedures were performed, and 5 of these children also underwent a therapeutic laparoscopy. Nineteen patients were treated in the acute setting and two in a delayed fashion. Overall, 19 of 21 laparoscopies correctly diagnosed the injury, and all the 5 laparoscopic therapeutic procedures were successful. There was a significant difference in success rate of diagnostic laparoscopy between acute and delayed cases (p < 0.01). Retrospectively, laparotomy was avoided in 13 of 21 patients overall and in 10 of 10 patients with penetrating trauma (p = 0.02). Conclusions: Laparoscopy is useful in the management of the hemodynamically stable pediatric patient with abdominal trauma but may be less valuable in cases with delayed presentation. Many intraabdominal injuries are amenable to laparoscopic repair. In patients with penetrating trauma, laparoscopy avoided laparotomy is more likely than in those with blunt abdominal trauma. Laparoscopy is currently underutilized in the management of pediatric abdominal trauma.

We reviewed the records of 233 patients with major trauma admitted to The Children's Hospital of Alabama during the first 2 years of operation of its Pediatric Trauma Center. The male-to-female ratio was 1.7:1. The highest incidence of trauma occurred in the spring (88 patients, 38%) and the lowest in the winter (36 patients, 15%). Most children (184, 79%) were injured between noon and midnight. Blunt mechanisms of injury accounted for 206 patients (88%), penetrating for 17 (7%), and burns for ten (4%). The distribution of injuries by organ system was head/neurologic, 185 patients (79%); musculoskeletal, 83 (36%); thoracic, 57 (24%); abdominal, 29 (12%); major soft-tissue, 26 (11%), genitourinary, 11 (5%); and vascular, 11 (5%). Surgery was required at some point during the hospitalization in 89 patients (38%). Seventy-two patients (31%) experienced 115 complications. The mean length of time spent for resuscitation and stabilization in the trauma room was 49 min. The mean ICU stay was 3.2 days. Total length of hospitalization averaged 11.2 days. Twenty-six patients (11%) died. The Pediatric Trauma Score and the Pediatric Coma Score were found to be predictive of outcome. The organization and function of the trauma team is described, and public health concerns are discussed.

OBJECTIVE Poor outcomes have been reported in patients with type 2 diabetes and coronavirus disease 2019 (COVID-19); thus, it is mandatory to explore novel therapeutic approaches for this population. RESEARCH DESIGN AND METHODS In a multicenter, case-control, retrospective, observational study, sitagliptin, an oral and highly selective dipeptidyl peptidase 4 inhibitor, was added to standard of care (e.g., insulin administration) at the time of hospitalization in patients with type 2 diabetes who were hospitalized with COVID-19. Every center also recruited at a 1:1 ratio untreated control subjects matched for age and sex. All patients had pneumonia and exhibited oxygen saturation RESULTS Of the 338 consecutive patients with type 2 diabetes and COVID-19 admitted in Northern Italy hospitals included in this study, 169 were on sitagliptin, while 169 were on standard of care. Treatment with sitagliptin at the time of hospitalization was associated with reduced mortality (18% vs. 37% of deceased patients; hazard ratio 0.44 [95% CI 0.29–0.66]; P = 0.0001), with an improvement in clinical outcomes (60% vs. 38% of improved patients; P = 0.0001) and with a greater number of hospital discharges (120 vs. 89 of discharged patients; P = 0.0008) compared with patients receiving standard of care, respectively. CONCLUSIONS In this multicenter, case-control, retrospective, observational study of patients with type 2 diabetes admitted to the hospital for COVID-19, sitagliptin treatment at the time of hospitalization was associated with reduced mortality and improved clinical outcomes as compared with standard-of-care treatment. The effects of sitagliptin in patients with type 2 diabetes and COVID-19 should be confirmed in an ongoing randomized, placebo-controlled trial.