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Traumatic asphyxia, which is manifested by facial edema, cyanosis, subconjunctival hemorrhage, and petechiae on the upper chest and abdomen, is a very rare clinical syndrome in children. In adults, the incidence of traumatic asphyxia was reported as 1 case/18,500 accidents, but the actual incidence is not known for pediatric population. Traumatic asphyxia is a mechanical cause of hypoxia resulting from sudden compression of the thoracic-abdominal region and the valsalva maneuver is necessary for the development of this syn-drome. Here, we describe a case of traumatic asphyxia with an ecchymotic mask in a 14-year-old boy who was referred to our pediatric emergency department.

© 2023 Wolters Kluwer Health, Inc. All rights reserved.Background The aim of the present study was to determine the accuracy of point-of-care ultrasound (POCUS) for detecting skull fractures and to evaluate sonographic measurements of optic nerve sheath diameter (ONSD) and ONSD/eyeball vertical diameter (EVD) ratios in children with head trauma. Methods Children who presented with local signs of head trauma and underwent cranial computed tomography (CT) were enrolled. The suspected area was examined by POCUS to identify a skull fracture, and then the ONSD at 3 mm posterior to the globe and the EVD were measured. Ratios of ONSD measurement at 3 mm/EVD were reported. All ONSD measurements and ratios were calculated from cranial CT images. Results There were 112 children enrolled in the study. The sensitivity and specificity of POCUS for skull fractures was 93.7% (95% confidence interval [CI], 82.8-98.6) and 96.8% (95% CI, 89.1-99.6), whereas the positive predictive value was 95.7% (95% CI, 85.1-98.8), and the negative predictive value was 95.3% (95% CI, 87.3-98.4). There was high agreement between POCUS and CT for identifying skull fractures (κ, 0.90 [±0.04]). In the group without elevated intracranial pressure findings on CT, patients with space-occupying lesions (SOLs) had higher sonographic ONSD measurements and ratios (P < 0.001) compared with cases without SOLs. Conclusions When used with clinical decision rules to minimize the risk for clinically important traumatic brain injury, POCUS seems to be a promising tool to detect skull fractures and calculate ONSD measurements and rates to predict the risk for SOLs and perform further risk stratification of children with minor head trauma.

Introduction: Pigtail catheters are currently recommended for draining pleural effusions. However, specific catheters manufactured for this purpose may not be feasible in resource-limited settings. This study evaluated the safety and effectiveness of a central venous catheter for treating uncomplicated pleural effusions with point-of-care ultrasound in children. Methods: The study was a single-center retrospective review of the clinical records of pediatric patients with symptomatic uncomplicated pleural effusion who had underwent bed-side ultrasound guided pleural drainage with a central venous catheter, between 2014 and 2019. Results: We determined 93 patients who had undergone 98 central venous catheter insertions during the study period. The patient’s median age was 4.5 years (range, 7 days to 15 years) and median weight was 19 kg (range, 3 to 60 kg). The most underlying cause was cardiovascular surgery. The technical success rate was 95.9% and only 2 (2.2%) complications were observed. Conclusion: Point of care ultrasound guided pleural drainage with a central venous catheter is safe and effective in critically ill children with uncomplicated pleural effusion.

Lactic acidosis is a major cause of metabolic acidosis in critically ill patients. Herein we report a child with relapsed non-Hodgkin’s lymphoma admitted to the pediatric intensive care unit (PICU) with profound lactic acidosis. On admission, he was treated with fluid replacement and a vasopressor, followed by continuous veno-venous hemodiafiltration to correct acidosis. As lactic acid levels remained high despite all treatments, thiamine was added to the therapy, which did not influence metabolic status either. Lactic acidosis could only be corrected by aggressive chemotherapy during his stay in the PICU. The patient died on the 68th day of PICU admission due to underlying progressive disease. Clinicians should start aggressive chemotherapy as soon as possible in patients with a recurrence or advanced cancer who have type-B lactic acidosis.

Background: This study evaluated of clinical characteristics, outcomes, and mortality risk factors of a severe multisystem inflammatory syndrome in children admitted to a the pediatric intensive care unit. Methods: A retrospective multicenter cohort study was conducted between March 2020 and April 2021 at 41 PICUs in Turkey. The study population comprised 322 children diagnosed with multisystem inflammatory syndrome. Results: The organ systems most commonly involved were the cardiovascular and hematological systems. Intravenous immunoglobulin was used in 294 (91.3%) patients and corticosteroids in 266 (82.6%). Seventy-five (23.3%) children received therapeutic plasma exchange treatment. Patients with a longer duration of the PICU stay had more frequent respiratory, hematological, or renal involvement, and also had higher D-dimer, CK-MB, and procalcitonin levels. A total of 16 patients died, with mortality higher in patients with renal, respiratory, or neurological involvement, with severe cardiac impairment or shock. The non-surviving group also had higher leukocyte counts, lactate and ferritin levels, and a need for mechanical ventilation. Conclusions: In cases of MIS-C, high levels of D-dimer and CK-MB are associated with a longer duration of PICU stay. Non-survival correlates with elevated leukocyte counts and lactate and ferritin levels. We were unable to show any positive effect of therapeutic plasma exchange therapy on mortality. Impact: MIS-C is a life-threatening condition.Patients need to be followed up in the intensive care unit.Early detection of factors associated with mortality can improve outcomes.Determining the factors associated with mortality and length of stay will help clinicians in patient management.High D-dimer and CK-MB levels were associated with longer PICU stay, and higher leukocyte counts, ferritin and lactate levels, and mechanical ventilation were associated with mortality in MIS-C patients.We were unable to show any positive effect of therapeutic plasma exchange therapy on mortality.

PageNumber: 279 Date of submission: 19March 2022Aretrospective evaluation of children's hospital admissions suffered from roadtraffic injurySerpilUğur Baysal1, Özge Yıldırım Şalbaş2, EmelUlusoy3, Nihan Şık3, Durgül Yılmaz3, MuratDuman31DokuzEylül University Faculty of Medicine, Department of Pediatrics, Division ofSocial Pediatrics, İzmir, Turkey2DokuzEylül University Faculty of Medicine, Department of Pediatrics, İzmir, Turkey3DokuzEylül University Faculty of Medicine, Department of Pediatrics, Division ofPediatric Emergency Medicine, İzmir, TurkeyBackground and Aims: Witheach passing year, the number of individuals injured in road traffic increasesin proportion to our country’s number of vehicles and growing population. Thisstudy aimed to analyze road injuries in children and reduce morbidity andmortality by determining the risk factors.Methods:Children admitted at the Dokuz Eylül University, Pediatric Emergency Departmentlast five years due to road traffic injuries, were retrospectively analyzed.1227 cases with complete data were included in the study. Descriptiveinformation about the children, their families, the event, injury characteristics,the follow-up, and the results were recorded in the Data Registration Form.Data were evaluated by frequency, percentage distribution, mean, median, andcomparative analysis.Results: Ofcases included in the study, 66.1% were male, and 33.9% were female. 35.7% ofthe injured are between the ages of 5-9. Most injuries occurred in June andJuly. The peak admission hours were between 16:00 and 20:00. 45.6% of them werepedestrians. The most frequently injured area was recorded as the head andneck. According to the Injury Severity Score, severe injury rates were 18.5%;it was found 3% according to the Glasgow Coma Scale. In in-vehicle injuries,12% of the cases had seat belts; 5.5% of children were using child safetyseats. 1.5% of the children wore protective clothing, and 26.7% wore a helmeton bicycles and motorcycles. 33.7% (n =414) of the cases were followed-up inthe ward. Hospitalizations were mostly made to the Pediatric EmergencyDepartment and the Department of Pediatric Surgery, and 9.7% of the injuredchildren had to undergo surgery. Most of the surgeries (64.7%) were performedat the Department of Orthopedics and Traumatology. 4.6% of the cases werefollowed-up at the Pediatric Intensive Care Unit. Disability developed in 2% ofthe injured children. Three children died from hemorrhagic shock, four childrenwith intracranial hemorrhage also died.Conclusion: Roadtraffic injury is a significant cause of morbidity, mortality, and disabilityduring childhood, especially for pedestrians.Learning Outcomes: Riskawareness is low and protective measures are still insufficient in our country.Individual counseling is needed during health care.https://phaa.eventsair.com/PresentationPortal/safety2022/safety22/Presentation/Update/ae871543-dcfe-4fa2-9de9-fd78fa1854de?draft=TrueDr. Serpil Uğur Baysal, professor ofpediatrics, is an attending physician at the Dokuz Eylül University, Departmentof Pediatrics, İzmir, Turkey. She had graduated as a medical doctor fromİstanbul University(İÜ) and had a fellowship in pediatrics at the İÜ CerrahpaşaFaculty of Medicine. She started work asa pediatrician at the İstanbulUniversity in 1987. She has PediatricEmergency Medicine and Pediatric Critical Care fellowships. She continues her studies in the fieldof Social Pediatrics. Special interests in this field are Injury Prevention andControl, Prevention of Child Abuse and Neglect, and Health Promotion ofChildren and Adolescents. Beginning as a medical student, sheconducted observations and research in pediatrics, pediatric intensive careunit, pediatric emergency medicine for 1-6 month periods in Finland (Universityof Oulu), Germany (Free University of Berlin), and the USA(Universities ofIllinois, Northwestern, Texas, Johns Hopkins, Pennsylvania). She had attended World Safety 2016 inTampere.

Background: During the coronavirus disease 2019 (COVID-19) pandemic, the world has a large number of reported COVID-19 cases and deaths. Information on characteristics and mortality rate of pediatric intensive care unit (PICU) cases with COVID-19 remains limited. This study aims to identify the risk factors for mortality related to COVID-19 in children admitted to PICU. Methods: A retrospective multicenter cohort study was conducted between March 2020 and April 2021 at 44 PICUs in Turkey. Children who were 1 month-18-year of age with confirmed COVID-19 admitted to PICU were included in the study. Children with multisystem inflammatory syndrome and asymptomatic for COVID-19 were excluded. Results: Of 335 patients with COVID-19, the median age was 6.8 years (IQR: 1.2-14) and 180 (53.7 %) were male, 215 (64.2 %) had at least one comorbidity. Age and gender were not related to mortality. Among 335 patients, 166 (49.5%) received mechanical ventilation, 17 (5.1%) received renal replacement therapy and 44 (13.1 %) died. Children with medical complexity, congenital heart disease, immunosuppression and malignancy had significantly higher mortality. On multivariable logistic regression analysis, organ failure index [odds ratio (OR): 2.1, 95 confidence interval (CI): 1.55-2.85], and having congenital heart disease (OR: 2.65, 95 CI: 1.03-6.80), were associated with mortality. Conclusions: This study presents detailed data on clinical characteristics and outcomes of patients with COVID-19 admitted to PICU in the first pandemic year in Turkey. Our study shows that having congenital heart disease is associated with mortality. In addition, the high organ failure score in follow-up predict mortality.

Meckel???s diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract and may cause serious complications such as intestinal obstruction, gastrointestinal hemorrhage, or inflammation with/without perforation, which can present with non-specific symptoms and signs. We report on the case of a 2.5-year-old boy admitted to our emergency department in poor condition, with compatible signs of decompensated hypovolemic shock. This case finally resulted in intestinal volvulus and internal hernia, a very rare combination of two complications of MD, as determined in the operating room.

Background The aim was to evaluate the epidemiological, clinical, laboratory, and radiologic data of children with SARS-CoV-2 positivity by polymerase chain reaction (PCR) together with treatment strategies and clinical outcomes and to evaluate cases of multisystem inflammatory syndrome in children (MIS-C) in this population. Methods This was a multicenter retrospective observational cohort study performed in the pediatric emergency departments of 19 tertiary hospitals. From March 11, 2020, to May 31, 2021, children who were diagnosed with confirmed nasopharyngeal/tracheal specimen SARS-CoV-2 PCR positivity or positivity for serum-specific antibodies against SARS-CoV-2 were included. Demographics, presence of chronic illness, symptoms, history of contact with SARS-CoV-2 PCR-positive individuals, laboratory and radiologic investigations, clinical severity, hospital admissions, and prognosis were recorded. Results A total of 8886 cases were included. While 8799 (99.0%) cases resulted in a diagnosis of SARS-CoV-2 with PCR positivity, 87 (1.0%) patients were diagnosed with MIS-C. Among SARS-CoV-2 PCR-positive patients, 51.0% were male and 8.5% had chronic illnesses. The median age was 11.6 years (IQR: 5.0–15.4) and 737 (8.4%) patients were aged

Objective: To evaluate the distribution and characteristics of respiratory viral pathogens and to assess the epidemiological data, clinical features, and prognoses of infected children in a pediatric emergency department during the COVID-19 pandemic.