Weight-training injuries in children and adolescents.

Thousands of children and adolescents participate in weight lifting for recreation or as a means of training for sports. Weight lifting can cause serious musculoskeletal injuries, such as ruptured intervertebral discs, spondylolysis and spondylolisthesis, fractures and meniscal injuries of the knee. Deaths related to weight lifting have been reported. Although the incidence of weight-lifting injuries is not well documented in children and adolescents, several reports indicate that few injuries occur in carefully supervised programs. The most common cause of injury appears to be loss of form when heavy weights are lifted. Proper technique, good supervision and training programs appropriate to the athlete's level of physical and emotional maturity are important.     

Snowboarding injuries in children and adolescents.

To study snowboarding injuries in children and adolescents, a 6-year retrospective study was conducted of patients 18 years old and younger admitted to a pediatric trauma center after snowboarding accidents. The study was designed to identify the most severely injured patients. Comparison was made to data from a recent comparable study of skiing injuries. Twenty-seven patients were identified, all but one male and none under 10 years old. Nineteen were injured in a fall, 6 collided with a stationary object, one collided with a skier, and in one case the mechanism of injury was unclear. The average pediatric trauma score was 10.5, and the average injury severity score 10.2. Most of the 12 head injuries were minor. Most extremity fractures were to the upper extremity. There were two lumbar vertebral burst fractures, suggesting that the sport may predispose to this injury. There were no deaths. When compared with skiing, in snowboarding the overall severity of injury is lower, collision is a less common mechanism of injury and results in less serious injury, head injuries are less severe, the relative frequency of upper extremity fracture is higher, abdominal injuries are caused by falls rather than collisions, and facial injuries are less common. These differences are predictable on the basis of differences in the equipment. However, it is too early to say that snowboarding has less potential for life-threatening injury than skiing. Expected changes in the mix of participants, with an increase in the average skill level over time, may well result in different patterns, mechanisms, and severity of injury.     

Serious winter sport injuries in children and adolescents requiring hospitalization

To describe the epidemiology of serious winter sports-related injuries resulting in hospitalization in children and adolescents, we prospectively collected and analyzed records of all winter sports-related injuries requiring hospitalization at our respective institutions from 1996 to 2000. We identified 101 patients with a mean age of 10.7 years, of whom 68% were male and 32% female. Skiers accounted for 71% and snowboarders 26% of injuries; 3% of injuries were snowmobile-or luge-related. Leading mechanisms of injury were ground level falls (50%), crashes into trees, (18%), and falls from ski lift (13%). Approximately 26% of the patients met criteria for trauma-team activation. Leading diagnoses were head injury (20%), femur fracture (18%), and concussion (11%). Five patients required admission to the intensive care unit. The median injury severity score (ISS) was 7; 8% of patients had an ISS score > 15. Abbreviated Injury Scale-1990 scores of > or = 3 were noted in 34% of the patients. We conclude that Injuries sustained through participation in winter sports may be severe, especially in the case of injuries involving the head. Injury-prevention strategies should focus on head injuries.     

Arthroscopy in the treatment of injuries and knee disorders in children and adolescents

Background. In children and young adolescents, like in adults the knee joint is the most exposed joint to the injuries and pathologies of various ethiology. Injuries of the knee joint in children and young adolescents have their own specificity and they are characterized by some differences. Therefore the diagnostics and management are difficult even for the experienced surgeons. Material and methods. The study is a retrospective analysis of 1552 arthroscopies of the knee joint in children and young adolescents performed in the years 1986-2001. These arthroscopies accounted for 14,4% of all 10770 arthroscopies. Conclusions. Arthroscopy is a decisive diagnostic examination in many cases of diseases of unknown ethiology. Particularly in acute injuries it allows for choosing a further method of treatment. In these conditions also operative arthroscopy is performed. The arthroscopy in children is restricted not by the size of the joint which is very elastic but by the surgeons experience.     

Sports injuries in adolescents

Musculoskeletal injuries are the most common injuries in youth sports. A number of growth-related factors unique to the adolescent age group play an important role in the epidemiology, types, and management of these injuries. These mainly relate to the physical and psychosocial growth and development during adolescence and are discussed in this article. Overuse injuries are more commonly seen in this age group in the primary care setting. Shoulder impingement, elbow and shoulder injuries related to throwing, stress injuries of the wrist, spondylolysis, and anterior knee pain are some of the overuse injuries reviewed in this article.     

交通伤急诊住院的青少年和儿童流行病学调查

目的了解青少年和儿童交通伤住院患者的来源、车祸发生区域、性别、年龄、受伤部位等特征。方法以2004至2005年间急诊收治的163例1～18岁青少年和儿童交通伤住院患者为研究对象,进行回顾性、描述性统计分析。结果外来人员子女、郊区及郊县儿童发生交通伤比例高;行人和机动车碰撞是最主要的受伤方式;5～9岁儿童发生交通伤害最多;伤害部位以头面部和四肢为主。结论应加强对外来人员子女、郊区和郊县儿童及家长的交通安全教育,其次对儿童乘客应加强安全防护;进一步规范儿童交通伤的救治。     

Uncovering the burden of intentional injuries among children and adolescents in the emergency department

Introduction

In low- and middle-income countries, injuries are a leading cause of mortality in children. Much work has been done in the context of unintentional injuries but there is limited knowledge about intentional injuries among children. The objective of this paper was to understand the characteristics of children with intentional injuries presenting to emergency departments in Pakistan.

Methods

The data was from the Pakistan National Emergency Departments Surveillance (Pak-NEDS), conducted from November 2010 to March 2011 in seven major emergency departments of Pakistan. Data on 30,937 children under 18 years of age was collected. This paper reports frequency of intentional injuries and compares patient demographics, nature of injury, and discharge outcome for two categories of intentional injuries: assault and self-inflicted injuries.

Results

Intentional injuries presenting to the emergency departments (EDs) accounted for 8.2% (2551/30,937) amongst all other causes for under 18 years. The boy to girl ratio was 1:0.35. Intentional injuries included assault (n = 1679, 65.8%) and self-inflicted injuries (n = 872, 34.2%). Soft tissue injuries were most commonly seen in assault injuries in boys and girls but fractures were more common in self-inflicted injuries in both genders.

Conclusion

Intentional injury is one of the reasons for seeking emergency treatment amongst children and a contributor to morbidity in EDs of Pakistan. Moreover, such injuries may be underestimated due to lack of reporting and investigative resources. Early identification may be the first step leading to prevention.

     

Characteristics and associated factors with sports injuries among children and adolescents

BACKGROUND:

The participation of children and adolescents in sports is becoming increasingly common, and this increased involvement raises concerns about the occurrence of sports injuries.

OBJECTIVES:

To characterize the sports injuries and verify the associated factors with injuries in children and adolescents.

METHOD:

Retrospective, epidemiological study. One thousand three hundred and eleven children and adolescents up to 18 years of age enrolled in a sports initiation school in the city of Presidente Prudente, State of São Paulo, Brazil. A reported condition inquiry in interview form was used to obtain personal data and information on training and sports injuries in the last 12 months. Injury was considered any physical complaint resulting from training and/or competition that limited the participation of the individual for at least one day, regardless of the need for medical care.

RESULTS:

The injury rate per 1000 hours of exposure was 1.20 among the children and 1.30 among the adolescents. Age, anthropometric data, and training characteristics only differed with regard to the presence or absence of injuries among the adolescents. The most commonly reported characteristics involving injuries in both the children and adolescents were the lower limbs, training, non-contact mechanism, mild injury, asymptomatic return to activities, and absence of recurrence.

CONCLUSIONS:

The injury rate per 1000 hours of exposure was similar among children and adolescents. Nevertheless, some peculiarities among adolescents were observed with greater values for weight, height, duration of training, and weekly hours of practice.     

Uncovering the burden of intentional injuries among children and adolescents in the emergency department

Background

Vital signs play a critical role in prioritizing patients in emergency departments (EDs), and are the foundation of most triage methods and disposition decisions. This study was conducted to determine the frequency of vital signs documentation anytime during emergency department treatment and to explore if abnormal vital signs were associated with the likelihood of admission for a set of common presenting complaints.

Methods

Data were collected over a four-month period from the EDs of seven urban tertiary care hospitals in Pakistan. The variables included age, sex, hospital type (government run vs. private), presenting complaint, ED vital signs, and final disposition. Patients who were >12 years of age were included in the analysis. The data were analyzed to describe the proportion of patients with documented vitals signs, which was then crossed-tabulated with top the ten presenting complaints to identify high-acuity patients and correlation with their admission status.

Results

A total of 274,436 patients were captured in the Pakistan National Emergency Department Surveillance (Pak-NEDS), out of which 259,288 patients were included in our study. Vital signs information was available for 90,569 (34.9%) patients and the most commonly recorded vitals sign was pulse (25.7%). Important information such as level of consciousness was missing in the majority of patients with head injuries. Based on available information, only 13.3% with chest pain, 12.8% with fever and 12.8% patients with diarrhea could be classified as high-acuity. In addition, hospital admission rates were two- to four-times higher among patients with abnormal vital signs, compared with those with normal vital signs.

Conclusion

Most patients seen in the EDs in Pakistan did not have any documented vital signs during their visit. Where available, the presence of abnormal vital signs were associated with higher chances of admission to the hospital for the most common presenting symptoms.

     

Employment outcomes of adults who sustained spinal cord injuries as children or adolescents

OBJECTIVES: To determine employment outcomes of adults with pediatric-onset spinal cord injury (SCI) and factors associated with those outcomes. DESIGN: Structured interview, including standardized measures. SETTING: Community. PARTICIPANTS: Individuals who sustained an SCI at age 18 years or younger, were 24 years or older at follow-up, did not have a significant brain injury, and were living in the United States or Canada. A total of 195 subjects were interviewed. Mean age at injury was 14 years (0-18 y), mean age at interview was 29 years (24-37 y), and mean duration of injury was 15 years (7-28 y). All participants had been enrolled in SCI programs. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: A structured interview, the FIM instrument, the Craig Handicap Assessment and Recording Technique, the Medical Outcomes Study 12-Item Short-Form Health Survey, and the Satisfaction with Life Scale. RESULTS: Of the participants, 99 (51%) were employed, 78 (40%) were unemployed, 12 (6%) were students, and 6 (3%) were homemakers. A predictive model of employment identified 4 factors associated with employment: education, community mobility, functional independence, and decreased medical complications. Other variables significantly associated with employment included community integration, independent driving, independent living, higher income, and life satisfaction. CONCLUSIONS: Compared with the general population, the high rate of unemployment among adults with pediatric-onset SCI is a cause for concern. Risk factors associated with adult unemployment provide guidelines for targeting rehabilitation resources and strategies.     

Obesity in children and adolescents

The prevalence of obesity in increasing worldwide, and its complications are now better recognized. As childhood obesity tracks into adulthood, the treatment and prevention of this condition is necessary early in life. This review describes the public health impact of pediatric obesity, its risk factors, and suggestions for its treatment and prevention, including behavior modifications, decrease in inactivity, increase in physical activity, and dietary changes.     

Headaches in children and adolescents

Headaches are common during childhood and become more common and increase in frequency during adolescence. The rational, cost-effective evaluation of children with headache begins with a careful history. The first step is to identify the temporal pattern of the headache--acute, acute-recurrent, chronic-progressive, chronic-nonprogressive, or mixed. The next step is a physical and neurologic examination focusing on the optic disc, eye movements, motor asymmetry, coordination, and reflexes. Neuroimaging is not routinely warranted in the evaluation of childhood headache and should be reserved for use in children with chronic-progressive patterns or abnormalities on neurologic examination. Once the headache diagnosis is established, management must be based on the frequency and severity of headache and the impact on the patient's lifestyle. Treatment of childhood migraine includes the intermittent use of oral analgesics and antiemetics and, occasionally, daily prophylactic agents. Often, the most important therapeutic intervention is confident reassurance about the absence of serious underlying neurologic disease.     

Surgery in children and adolescents

The authors explain the second phase in surgery procedure which is known as intra-operative, developing a standardized model of nursing care for children and adolescents during the intra-operative phase. This phase commences in the operating room from the moment the child/adolescent arrives after being brought from a hospital ward and lasts until the child/adolescent is transferred to the recovery room. The authors perform a systematic and holistic evaluation, using the Gordon Functional Health Patterns. The authors select the Nursing Diagnoses of NANDA, the North American Nursing Diagnosis Association, which most frequently appear in this intra-operative phase: risk of lesion, risk of infection, risk of hypothermia, and risk of asphyxiation. The authors also mention the potential complications which could appear during an operation according to the age of the child, the type of anesthesia used, the surgical technique used, and the overall health of the patient prior to surgery. Finally, the authors describe the nursing treatments related to the potential complications and the outlined nursing diagnoses.     

Loneliness in children and adolescents

Feeling lonely is a sad but relatively common experience for children, adolescents, and adults. When loneliness becomes a frequently occurring phenomenon, there are serious implications for emotional and physical well-being. The concept of loneliness can be described in relation to psychosocial development. Loneliness in children and adolescents is a relatively new research topic. In this paper the author reviews research for both age groups. Pediatric nurses should recognize the importance of identifying children and adolescents at high risk for the development of chronic loneliness. Nursing interventions for assisting the lonely child or adolescent are described briefly.