Journal of Trauma and Injury

Original Article

Comparison of pediatric injury patterns before and during the COVID-19 pandemic in Korea: a retrospective study: Geom Pil Nam, Woo Sung Choi, Jin-Seong Cho, Yong Su Lim, Jae-Hyug Woo, Jae Ho Jang, Jea Yeon Choi; J Trauma Inj. 2023;36(4):343-353. Published online December 22, 2023; DOI: https://doi.org/10.20408/jti.2023.0053

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Abstract PDF Supplementary Material: Purpose
The COVID-19 pandemic led to significant changes in the lifestyle patterns of children and affected the patterns of pediatric injuries. This study analyzed the changing patterns of pediatric injury overall and by age groups, based on the datasets before and during the COVID-19 pandemic.
Methods
This study is based on the data of patients who presented with injuries at 24 hospital emergency departments participating in the Emergency Department-based Injury In-depth Surveillance (EDIIS) conducted by the Korea Disease Control and Prevention Agency. The surveillance data was categorized by injury mechanism, location, activity, and severity. We analyzed the injury patterns of pediatric patients aged 0 to 15 years. Subgroup analysis was conducted by age group in children aged 7 to 15 years, 1 to 6 years, and <1 year.
Results
The study periods were March 12, 2018, to December 31, 2019 (pre–COVID-19 period) and March 12, 2020, to December 31, 2021 (COVID-19 pandemic period). A total of 222,304 patients aged ≤15 years were included in the study. When comparing the COVID-19 pandemic period to the pre–COVID-19 period, the total number of pediatric patients with injuries decreased by 38.7%, while the proportions of in-home injuries (57.9% vs. 67.9%), and minor injuries (39.3% vs. 49.2%) increased. In the 7 to 15 years group, bicycle riding injuries (50.9% vs. 65.6%) and personal mobility device injuries (2.4% vs. 4.6%) increased. The 1 to 6 years group also showed an increase in bicycle accident injuries (15.8% vs. 22.4%). In the <1 year group, injuries from falls increased (44.5% vs. 49.9%). Self-harm injuries in the 7 to 15 years group also increased (1.6% vs. 2.8%).
Conclusions
During the COVID-19 pandemic period, the overall number of pediatric injuries decreased, while injuries occurring at home and during indoor activities increased. Traffic accidents involving bicycles and personal mobility devices and self-harm injuries increased in the 7 to 15 years group. In the <1 year group, the incidence of falls increased. Medical and societal preparedness is needed so that we might anticipate these changes in the patterns of pediatric injuries during future infectious disease pandemics.; Summary

Review Article

Delayed union of a pediatric lunate fracture in the United Kingdom: a case report and a review of current concepts of non-scaphoid pediatric carpal fractures: Timothy P. Davis, Elizabeth Headon, Rebecca Morgan, Ashley I. Simpson; J Trauma Inj. 2023;36(4):315-321. Published online December 20, 2023; DOI: https://doi.org/10.20408/jti.2023.0038

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Abstract PDF: Pediatric carpal fractures are rare and often difficult to detect. This paper reviews the current literature on pediatric non-scaphoid carpal fractures, with a case report of a lunate fracture associated with a distal radius and ulnar styloid fracture, managed nonoperatively in a 12-year-old boy. There is lack of consensus regarding the management of these fractures due to the low number of reported cases. A frequent lack of long-term follow-up limits our understanding of the outcomes, but good outcomes have been reported for both nonoperative and operative management. This case report brings attention to the current time period for the definition of delayed union in pediatric carpal fractures, and emphasizes the need for prolonged follow-up for the detection of delayed complications leading to functional impairment.; Summary

Original Articles

Pediatric Hand Trauma: An Analysis of 3,432 Pediatric Hand Trauma Cases Over 15 Years: Ki Pyo Sung, Soo Hyang Lee; J Trauma Inj. 2021;34(4):257-262. Published online October 15, 2021; DOI: https://doi.org/10.20408/jti.2021.0037

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Abstract PDF: Purpose
Pediatric hand trauma is common and sometimes causes deformity or disability. The incidence and etiologies of hand trauma in children are different from those in adults. This study analyzed the characteristics of pediatric hand trauma cases and patients over a 15-year period.
Methods
We conducted a retrospective medical record review of 3,432 children (2,265 boys, 1,167 girls, under 18 years of age) with hand injuries from January 2005 to December 2019. We evaluated the sex distribution and injury etiologies. Injuries were classified by type as burns, amputations, crushing injuries, lacerations, extensor and flexor tendon injuries, open and closed fractures, and nerve injuries.
Results
Among the pediatric hand injury patients, males were predominant (1.94:1). Simple lacerations (58.4%) were the most common injury type, followed by fractures (22.8%). Lacerations and burns tended to be common in younger age groups, while tendon injuries, nerve injuries, and crushing injuries were more frequently encountered in older age groups.
Conclusions
Hand trauma prevention strategies should be established considering the frequent trauma etiologies in specific age groups. An awareness of age-specific characteristics of pediatric hand trauma patients will be helpful to prevent hand trauma.; Summary

Peripheral Arterial Injuries in Pediatric Age Group: Ahmed A R Ammar; J Trauma Inj. 2016;29(2):37-42. Published online June 30, 2016; DOI: https://doi.org/10.20408/jti.2016.29.2.37

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6 Citations

Abstract PDF

PURPOSE
Arterial injury in children is a challenging problem for its special characteristics. It is rare even during warfare. This review described a personal experience in the management and outcome of acute pediatric arterial injuries of extremities.
METHODS
Thirty-six children below age of 13 years were studied during period from 2004 through 2014 in Iraq.
RESULTS
Male patients were 27 (75%) and female were 9 (25%). Seven to twelve years old was the most affected age group. The incidence of iatrogenic injuries was greater in infants and toddlers while penetrating injuries were the most common in older children. Upper limbs arteries were affected in 17 (47.2%) and lower limb in 19 (52.8%) patients. Hard signs were the commonest mode of presentation (83.3%). Lateral wall tear and complete transection were the most frequent types of arterial injury (36.1% and 27.8% respectively). The most frequent procedures performed were end-to-end anastomosis and lateral arteriorrhaphy. Surgical outcome was good. In 27 cases distal pulsations were regained. Seven cases had impalpable distal pulses but still viable limbs. Limb length discrepancy was detected in one case. One case was complicated with limb loss. No death was recorded.
CONCLUSION
Arterial injuries in children are age related. The proper treatment of arterial injuries in children requires high index of suspicion, early operative intervention and continuous postoperative follow-up throughout years of active growth. Angiogram has a limited role as a diagnostic tool in acute arterial injuries.

Summary

Citations

Citations to this article as recorded by

Traumatic brachial artery dissection in a pediatric patient: An interdisciplinary approach to care
Katherine Kazen, Jeremy Powers, Steven Hopkins, Brad Feltis
Journal of Pediatric Surgery Case Reports.2022; 85: 102403. CrossRef
Operative management and outcomes of peripheral vascular trauma in pediatric and adolescent population
Madhur Kumar, Subrata Pramanik, Anubhav Gupta
Indian Journal of Vascular and Endovascular Surger.2021; 8(5): 66. CrossRef
TREATMENT OF ARTERIAL TRAUMA IN PATIENTS OF VARIOUS AGES
Vitaliy Petrov, Roman Trutiak, Boris Dyachushun, Roksolana Yaremkevych, Ihor Kobza
Proceedings of the Shevchenko Scientific Society. .2021;[Epub] CrossRef
Peripheral Arterial Injuries in Children: An Audit at a University Hospital in Developing Country
Zia Ur Rehman, Amna Riaz, Zafar Nazir
Annals of Vascular Diseases.2020; 13(2): 158. CrossRef
Age differences of arterial trauma – Selection of the most appropriate age classification
Vitaliy Petrov
Polish Annals of Medicine.2020;[Epub] CrossRef
Operative management of non-iatrogenic pediatric and adolescence peripheral arterial trauma: An experience from a resource challenged setting
Ahmed Mousa, Ossama M. Zakaria, Ibrahim Hanbal, Tamer A. Sultan, Amr M. El-Gibaly, Mohamed Y. Zakaria, Mohammed A. Nasr, Bosat E. Bosat, Alaa Sharabi, Mohamed Neinaa, Mohamed Abd El-Hamid, Mohamed Y. Daoud, Mahsoub M. Amin, Ahmed M. Odeh, Omer M. Alhaieg,
Asian Journal of Surgery.2019; 42(7): 761. CrossRef

Analysis of Delayed Diagnosis of Pediatric and Adolescent Patients Injured by Minor Trauma: Jee Ahn Choi, Won Bin Park, Jin Joo Kim, Jin Sung Jo, Jae Kwang Kim, Yong Su Lim, Sung Youl Hyun, Ho Seong Jeong, Hyuk Jun Yang, Gun Lee; J Korean Soc Traumatol. 2009;22(2):212-217.

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Abstract PDF: PURPOSE
To analyze delayed diagnosis, we collected date on pediatric and adolescent patients who had been admitted to the Emergency Department with injuries due to minor trauma METHODS: We retrospectively analyzed the age distribution, trauma mechanism, time interval for each affected body region at delayed diagnosis, hospital stay, and outcome for 161 pediatric and adolescent patients who had been admitted to the Emergent Department of Gachon University Gil Hospital from January 2006 to September 2008.
RESULTS
The incidence of delayed diagnosis in pediatric and adolescent trauma was 11.8% in our retrospective review of 161 pediatric and adolescent patients. Lengths of hospitalization were longer in patients with delayed diagnosis (p<0.05). Patients with delayed diagnosis were more often transferred to other hospitals than patients with non-delayed diagnosis (p<0.05). The time intervals for each different affected body regions at delayed diagnosis were significantly different, but the hospital stays were not. There were no statistical significance to age on affected body region.
CONCLUSION
From this study, we found that admission result and hospital stay were statistically significant differences between the delayed-diagnosis patient group and the non-delayed-diagnosis patient group. Finally, we must follow up pediatric and adolescent patients with minor trauma, closely considering missed injuries.; Summary

Practical Approach to the Diagnosis of Pediatric Nasal Bone Fractures: Yulkok Lee, Sungchan Oh, Sukjin Cho, Hyejin Kim, Taekyung Kang, Seungwoon Choi, Hanbin Yoo, Seokyong Ryu; J Trauma Inj. 2014;27(4):95-100.

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Abstract PDF: PURPOSE
Nasal bone fractures are the most common childhood facial bone fractures, with an incidence of about 39%. While taking a nasal bone x-ray is a common modality used in the emergency department, reports have expressed concerns with its low sensitivity and low specificity. Our study was aimed at comparing accuracy of physical and x-ray examination with that of facial bone computed tomography (CT).
METHODS
Electronic medical records (EMR) were retrospectively reviewed for patients under the age of 15 who visited our emergency department from January 2010 to December 2011with a chief complaint of nasal pain due to trauma and who had also undergone a nasal bone x-ray and facial bone CT. Patients who had not taken facial bone CT, who had been transferred, and who did not have EMR were excluded. We divided the patients into 2 groups, those who had nasal bone fractures and those without a fracture on their facial bone CT. We analyzed other parameters such as age, sex, and type of fracture to find statistical differences between the two groups.
RESULTS
A total of 209 patients were included. The patients with nasal bone fractures on their facial bone CT were older, and their traumas were more violent. Ten patients who had apparent nasal bone fractures on their facial bone CT had no definite signs of a fracture on their plain x-ray.
CONCLUSION
Though facial bone CT is an effective modality in detecting nasal bone fractures, in evaluating younger patients suspected of having nasal bone fractures, prudent use of facial bone CT is needed to reduce unnecessary exposure to radiation.; Summary

The Use of Brain Computer Tomography Examination with Mild Traumatic Brain Injury in Pediatrics: Ha Kyung Kim, Jin Joo Kim, Jin Seong Cho, Jae Ho Jang, Hyuk Jun Yang, Gun Lee; J Trauma Inj. 2014;27(3):63-70.

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Abstract PDF: PURPOSE
In children, mild traumatic brain injuries (TBI) account for 70~90% of head injuries. Without guidelines, many of these children may be exposed to excess radiation due to unnecessary imaging. The purpose of this study was to evaluate the impact of a mild TBI guideline in imaging of pediatric patients.
METHODS
The medical records of all children who had head computed tomography and were admitted to our hospital with a TBI with Pediatric Glasgow Coma Scale and Glasgow Coma Scale of 14 to 15 were retrospectively reviewed and compared with PECARN Rule.
RESULTS
A total of 1260 children were included and all children checked with head computed tomography. 61 pediatrics had CT positive and presented skull fracture 40, hemorrhage 8, hemorrhagic contusion 7, and diffuse axonal injury 1. Also, 4 patients diagnosed both skull fracture and brain haemorrhage and 1 patient diagnosed both haemorrhage and haemorrhagic contusion.
CONCLUSION
There are many pediatric traumatic patients who exposed to radiation due to CT. But, the most of results were negative. So, consider to follow the CT guideline for children and many do not require brain CT.; Summary

Car-tire-related Crushing Injury of the Lower Leg in Children: Jaeyeon Choi, Jaeho Jang, Jaehyuck Woo, Wonbin Park, Jinjoo Kim, Sungyeol Hyun, Geun Lee, Jeehoon Gwak; J Trauma Inj. 2013;26(3):175-182.

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Abstract PDF: PURPOSE
Crushing injuries by car tires result from a combination of friction, shearing, and compression forces and the severity of injury is influenced by the acceleration. Because car-tire injuries of the lower leg in children are common these days but they have received little attention; thus, our purpose was to look closely into this problem.
METHODS
A retrospective analysis was conducted of data from children under 15 years old age who visited an emergency department because of a car-tire-related crushing injury to the lower leg in pedestrian traffic accident from January 2008 to September 2012. The patient's age, sex, site of injury, degree of injury, associated injuries, type of surgery, and complications were reviewed.
RESULTS
There were 39 children, the mean age was 8.0 years, and 71.8% were boys. The dorsal part of the leg was involved most frequently. According to the severity classification, 15 children were grade I, 6 were grade II, and 18 were grade III. Among 24 patients, 13 were treated with skin graft and 3 were treated using a sural flap. Twelve patients developed complications, such as hypertrophic scarring, contractures, and deformities with significant bone loss.
CONCLUSION
Various degrees of skin or soft tissue defects were caused in children by car tires. In this study, patients were often also had tendon or bone damage. Proper and timely initial treatments are needed to reduce the incidence of infection, the number of operative procedures, and the hospital stay.; Summary

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