Discrimination of culture negative pyelonephritis in children with suspected febrile urinary tract infection and negative urine culture results

BackgroundWe investigated whether the C-reactive protein (CRP) level, urine electrolytes, and urine sodium-potassium ratio (uNa/K) could be useful markers for discriminating children with culture negative pyelonephritis (CNP) from children with suspected febrile urinary tract infection (fUTI) and negative urine culture results.MethodsWe examined 264 children experiencing their first fUTI consecutively admitted to our hospital between January 2011 and October 2014. Blood tests (CRP, white blood cell count [WBC], erythrocyte sedimentation rate [ESR], electrolytes) and urine tests (urine protein to creatinine ratio [uProt/Cr], electrolytes, uNa/K) were performed upon admission. All children with fUTI underwent 99m-dimercaptosuccinic acid (DMSA) scanning at admission. Data were compared between children with acute pyelonephritis (APN), CNP, lower UTI and controls. Using multiple logistic regression analysis (MLRA), the ability of these parameters to predict a cortical defect on DMSA scan (APN and CNP) was analyzed.ResultsThe laboratory findings of CNP children were similar with those of APN children except uProt/cr. The CRP level, WBC count, and ESR were higher in children with CNP, while uNa and uNa/K were lower than in children with lower UTI and control. By MLRA, CRP levels and uNa/K were the most relevant factors for predicting a cortical defect on DMSA scan (P = 0.002, <0.001, respectively).ConclusionWe conclude that the combination of CRP or WBC and uNa/K are useful for discriminating children with CNP from children with suspected fUTI and negative urine culture results.     

A state-wide analysis of pediatric scald burns by tap water, 2016–2018

IntroductionUnsafe tap water temperatures (>120 °F) are a risk factor for pediatric burns, which may disproportionally impact low-income, urban communities. We sought to estimate the incidence and demographic characteristics of tap water burns and their association with housing characteristics.MethodsWe performed a secondary data analysis to summarize emergency department discharge records from 2016 to 2018 involving children <18 years with an ICD-10-CM code for tap water burn (X11), and town-level housing data from the American Community Survey. Unpaired student’s t-test and spearman’s correlation analysis were performed for comparative analyses.ResultsA total of 146 tap water burn visits were identified, representing an incidence of 2 per 10,000 ED visits. The majority of cases were male, non-Hispanic White, of public insurance type, and from an urban CT town. The median age was 3 years, with 58% of cases <5 years. Towns with at least one tap water burn had a significantly higher average percentage of multi-family unit and renter housing as compared to towns with no tap water burns (p < 0.0001).ConclusionsOur results identified a significant number of tap water burns in children. Primary prevention efforts targeting education or regulation of water temperatures may work to reduce burns in underserved areas.     

Gaps in access to comprehensive rehabilitation following traumatic injuries in children: A nationwide examination

IntroductionAcute rehabilitation following traumatic injuries is associated with improved functional recovery. Access is often limited to patients at the time of hospital discharge. This phenomenon remains less well described in children, who may have more to benefit with rehabilitation posttrauma. This study aims to determine factors influencing access to rehabilitation among children with traumatic injuries utilizing a nationally representative sample.MethodsThe Kids Inpatient Database (2000–2012) was queried for trauma patients. The outcome measure of interest was discharge with rehabilitative services [acute rehabilitation facilities or home healthcare (HHC)]. Patients that did not survive and those that did not meet hospital admission criteria were excluded. Multivariable models adjusted for age, race/ethnicity, gender, insurance-status, income, injury severity score, year, children's hospital designation, hospital-volume, teaching status, location, and geographical region.ResultsA total of 811,941 records were included. These were predominantly male (65.9%) with an average age of 11.6 (± 6.7) years. 4.2% were discharged to rehabilitation facilities, and 3.9% were discharged with HHC. African-American and Hispanic patients were less likely to be placed/have access to rehabilitation facilities (p < 0.001). Similarly, uninsured patients were less likely to receive these services postdischarge (p < 0.05). However, patients with government insurance, those in the highest income-quartile, those treated at children's hospitals, and those treated at teaching and urban hospitals were more likely to be placed/have access to rehabilitation services.ConclusionRace/ethnicity and insurance status are associated with disparities in access to postdischarge rehabilitation in pediatric trauma patients. Moreover, treatment at designated children's, teaching and urban hospitals better-facilitates discharge planning with rehabilitative services.     

Chikungunya disease among infants in French West Indies during the 2014 outbreak

BackgroundWe aimed to describe the clinical and laboratory features of Chikungunya disease in infants aged from 1 month to 2 years.MethodsThis epidemiologic study was carried out at the Pointe-à-Pitre University Hospital from May to September 2014. We collected data prospectively from infants hospitalized for Chikungunya disease.ResultsA total of 154 infants were included. Hyperthermia was greater than 38.5 °C the first 48 h and during on average 2.7 days. Pain (on mobilization and/or cutaneous hyperesthesia and/or arthralgia) was present in 82% of the cases. Loss of appetite was reported for 62% of the infants. Initial maculopapular erythematous eruption occurred in 69% of the cases. A vesiculobullous eruption was secondarily observed in 7% of the cases. Edema on the feet and/or hands was present in 48% of the cases. Febrile seizure was observed in 12% of the cases. Lymphopenia was the most frequent laboratory finding, present in 94% of the infants. No cases of thrombocytopenia were observed. The reported complications were: bullous epidermolysis, state of epilepticus, and severe acute hepatitis.ConclusionThis study highlights a suggestive clinical presentation of Chikungunya diseases combining pain, fever, tachycardia, foot and/or hand edema. Lymphopenia, monocytosis, and the absence of thrombocytopenia were relevant biological signs.