OBJECTIVES:Nasal irrigation is a safe and low-cost procedure. This study explores parents' knowledge, attitudes, and behaviors regarding nasal irrigation for young children. METHODS:We conducted a prospective, exploratory study at Ankara Bilkent City Hospital from August to September 2024, surveying parents of patients aged 0-24 months in the Pediatric Emergency Department. The survey collected data on demographic information, nasal cleaning practices, and related knowledge, attitudes, and behaviors. Data was compared across three age groups: 0-6 months (Group 1), 7-12 months (Group 2), and 13-24 months (Group 3). RESULTS:A total of 107 parents participated. Nasal irrigation was most commonly used for nasal congestion (79%) and difficulty breathing (44%), and was mainly performed once a day (30%) or 2-3 times a day (26%). The most preferred tools for nasal irrigation were syringes (58%) and normal saline solution (81%). Seventy-four participants stated they were effectively performing nasal irrigation. Twenty-one reported receiving training on nasal irrigation, and 36 expressed a desire to receive training on nasal irrigation. Only four (3.7%) participants correctly answered all the knowledge-assessment questions about nasal irrigation, while 19 (17.8%) responded accurately to six out of seven questions. The median total score was 4 [3-5], and there was no significant difference between the groups (Group 1: 5 [3-5], Group 2: 4 [3-5], Group 3: 4 [3-5], 4 [3-5], p = 0.972). No significant association was found between the employment status of the parents and the total score (p = 0.494 and p = 0.645, respectively). Parents in Group 1 demonstrated a lower frequency of correctly answering the statement regarding accurate head positioning during nasal irrigation (p = 0.025). CONCLUSION:Most parents of young children presented to the pediatric emergency department have insufficient knowledge of nasal irrigation. Targeted educational initiatives and awareness campaigns are needed to enhance parents' understanding and promote the effective use of nasal irrigation.

ObjectivesAlthough human bocavirus (HBoV) is primarily linked to respiratory tract infections, its exact role as a respiratory pathogen remains unclear. This study aims to investigate HBoV detection rates, as well as clinical, laboratory, microbiological, and radiological characteristics, length of stay in the emergency department (ED), rate of hospitalization, and severity of illness in cases where HBoV is detected in respiratory secretions.MethodsWe conducted a retrospective analysis of all consecutive patients under 18 years who visited a large-volume tertiary pediatric ED from January to December 2023 and tested positive for HBoV in their respiratory viral panel (RVP).ResultsAmong the 14,315 patients who underwent RVP testing during the study period, 591 (4%) tested positive for HBoV. After excluding those with incomplete data, 528 patients (57% male) were included in the analyses. The median age was 2.8 [1.2-4.9] years. The most common symptoms were cough (67%), fever (58%), runny nose/nasal congestion/sore throat (34%), and respiratory distress (24%). Thirty percent of the patients had a history of antibiotic use before admission. Thirteen percent of the patients had at least one chronic illness. Co-infection with HBoV occurred in 37% of the patients, with respiratory syncytial virus (RSV) being the most frequently co-detected virus (45%). Lymphopenia was documented in 12% of patients, and 36% had elevated C-reactive protein levels (median 21 [12-38] g/dl). Abnormal chest X-rays were noted in 85% of patients. The management approach included outpatient care for more than half of the patients (69%). Clinical severity was classified as high in 11% of patients (n = 60), necessitating ICU admission.ConclusionAlthough typically mild, HBoV infections can escalate to severe respiratory illnesses, requiring respiratory support and intensive care.

Purpose: Brain tissue hypoxia is associated with poor outcomes after pediatric traumatic brain injury. Although invasive brain oxygenation (PbtO(2)) monitoring is available, noninvasive methods assessing correlates to brain tissue hypoxia are needed. We investigated EEG characteristics associated with brain tissue hypoxia. Methods: We performed a retrospective analysis of 19 pediatric traumatic brain injury patients undergoing multimodality neuromonitoring that included PbtO(2) and quantitative electroencephalography(QEEG). Quantitative electroencephalography characteristics were analyzed over electrodes adjacent to PbtO(2) monitoring and over the entire scalp, and included power in alpha and beta frequencies and the alpha-delta power ratio. To investigate relationships of PbtO(2) to quantitative electroencephalography features using time series data, we fit linear mixed effects models with a random intercept for each subject and one fixed effect, and an auto-regressive order of 1 to model between-subject variation and correlation for within-subject observations. Least squares (LS) means were used to investigate for fixed effects of quantitative electroencephalography features to changes in PbtO(2) across thresholds of 10, 15, 20, and 25 mm Hg. Results: Within the region of PbtO(2) monitoring, changes in PbtO(2) < 10 mm Hg were associated with reductions of alpha-delta power ratio (LS mean difference -0.01, 95% confidence interval (CI) [-0.02, -0.00], p = 0.0362). Changes in PbtO(2) < 25 mm Hg were associated with increases in alpha power (LS mean difference 0.04, 95% CI [0.01, 0.07], p = 0.0222). Conclusions: Alpha-delta power ratio changes are observed across a PbtO(2) threshold of 10 mm Hg within regions of PbtO(2) monitoring, which may reflect an EEG signature of brain tissue hypoxia after pediatric traumatic brain injury.

We aimed to investigate clinical and laboratory characteristics of acute alcohol intoxication (AAI) in adolescents who presented to the pediatric emergency department (ED) at a tertiary referral center from 2006 to 2019. All consecutive adolescents with AAI (n = 335) and their sex- and age-matched control subjects (n = 335) with undetectable ethanol levels were included in this case-matched study. Mean serum ethanol level was 156.4 ± 58.4 (range: 50.8-341.2) mg/dL in the acute alcohol intoxication (AAI) group. Glasgow coma scores were lower in AAI group (14 [14-15] vs 15 [15-15], P < .001). Acidosis (16.3%), hyperlactatemia (60.9%), hypoglycemia (1.7%), hypernatremia (2.2%), hypokalemia (12.3%), hyperchloremia (20.4%), hypocalcemia (13.9%), hypermagnesemia (9.7%), and hyperalbuminemia (10.4%) were significantly more common in the AAI group than the control group. Blood pH, lactate, Na+, K+, Ca++, Mg++, albumin, blood urea nitrogen (BUN), and uric acid levels were correlated with serum ethanol levels. This study shows that AAI frequently leads to mild to moderate metabolic/biochemical derangements in adolescents.

Objectives: Over-testing and over-treatment are common in children with croup at pediatric emergency departments (PED). The objective of the study was to improve care for children with croup. Methods: In this quality improvement (QI) initiative, all pediatric residents starting their rotation in the PED attended an informative presentation about croup and were provided reminders throughout their rotation. The primary outcome of this QI initiative was to reduce nebulized epinephrine (NE) use among children with mild croup by 50% over 7 months. The secondary outcome was to reduce X-rays by 50% over 7 months. Other outcomes included the administration of dexamethasone to all children with croup, reduction of antibiotics, laboratory tests, and revisits, and shortening the duration between physical examination to dexamethasone and NE treatments, and the length of stay (LOS) at the PED. Results: NE administration to patients with mild croup decreased from 80.2% to 36.3% (p < 0.001). The proportion of children with X-rays decreased from 37.4% to 17.1% (p < 0.001). There was a significant increase in dexamethasone administration, and significant decreases in laboratory blood tests, expanded viral PCR panel tests, and antibiotic prescription among all croup cases (p < 0.001). Revisit rates were not significantly different (p > 0.05). Time to dexamethasone and LOS shortened significantly (p < 0.001). Conclusion: With this QI intervention, decreases in the rate of administration of NE to mild croup cases, antibiotic prescription, X-ray, laboratory blood and respiratory PCR panel tests in all croup cases were achieved without an increase in revisits. However, unnecessary NE, antibiotic, and X-ray rates are still high.

Abstract Background Neonatal hypoxia ischemia (HI) related brain injury is one of the major causes of life-long neurological morbidities that result in learning and memory impairments. Evidence suggests that male neonates are more susceptible to the detrimental effects of HI, yet the mechanisms mediating these sex-specific responses to neural injury in neonates remain poorly understood. We previously tested the effects of treatment with a small molecule agonist of the tyrosine kinase B receptor (TrkB), 7,8-dihydroxyflavone (DHF) following neonatal HI and determined that females, but not males exhibit increased phosphorylation of TrkB and reduced apoptosis in their hippocampi. Moreover, these female-specific effects of the TrkB agonist were found to be dependent upon the expression of $$\text{ER}\alpha$$ ER α . These findings demonstrated that TrkB activation in the presence of $$\text{ER}\alpha$$ ER α comprises one pathway by which neuroprotection may be conferred in a female-specific manner. The goal of this study was to determine the role of $$\text{ER}\alpha$$ ER α -dependent TrkB-mediated neuroprotection in memory and anxiety in young adult mice exposed to HI during the neonatal period. Methods In this study, we used a unilateral hypoxic ischemic (HI) mouse model. $$\text{ER}\alpha$$ ER α +/+ or $$\text{ER}\alpha$$ ER α −/− mice were subjected to HI on postnatal day (P) 9 and mice were treated with either vehicle control or the TrkB agonist, DHF, for 7 days following HI. When mice reached young adulthood, we used the novel object recognition, novel object location and open field tests to assess long-term memory and anxiety-like behavior. The brains were then assessed for tissue damage using immunohistochemistry. Results Neonatal DHF treatment prevented HI-induced decrements in recognition and location memory in adulthood in females, but not in males. This protective effect was absent in female mice lacking $$\text{ER}\alpha$$ ER α . The female-specific improved recognition and location memory outcomes in adulthood conferred by DHF therapy after neonatal HI tended to be or were $$\text{ER}\alpha$$ ER α -dependent, respectively. Interestingly, DHF triggered anxiety-like behavior in both sexes only in the mice that lacked $$\text{ER}\alpha$$ ER α . When we assessed the severity of injury, we found that DHF therapy did not decrease the percent tissue loss in proportion to functional recovery. We additionally observed that the presence of $$\text{ER}\alpha$$ ER α significantly reduced overall HI-associated mortality in both sexes. Conclusions These observations provide evidence for a therapeutic role for DHF in which TrkB-mediated sustained recovery of recognition and location memories in females are $$\text{ER}\alpha$$ ER α -associated and dependent, respectively. However, the beneficial effects of DHF therapy did not include reduction of gross tissue loss but may be derived from the enhanced functioning of residual tissues in a cell-specific manner.

BACKGROUND: Thoracic trauma is a significant cause of mortality, especially among those arriving at hospitals. This study explores the associations between mortality, the shock index (SI), and specific metabolic and biochemical markers in patients with isolated thoracic trauma. METHODS: This retrospective cross-sectional study included all consecutive adult patients presenting with isolated thoracic trauma to a high-volume emergency department from January 2019 to December 2023. The predictive capability of SI levels and selected biomarkers upon admission for estimating mortality was assessed by determining the areas under the receiver operating characteristic curves (AUCs). Optimal cutoff values were determined using the Youden index method. RESULTS: The study involved 352 patients, with 285 (81%) being males and an average age of 50.0 +/- 17.7 years. The mortality rate was 9.6%. Mortality was significantly associated with higher shock index (odds ratio [OR]: 14.02, [95% confidence interval [CI] 0.8470.916], AUC=0.885, p=0.001), glucose/potassium ratio (OR: 1.24 [95% CI 1.14-1.35], AUC=0.869, p<0.001), and lactate levels (OR: 4.30 [95% CI 2.29-8.07], AUC=0.832, p<0.001). The optimal cutoff values determined for the shock index, glucose/potassium ratio, ionized calcium, and lactate were 1.02 (sensitivity, 94.1%; specificity 69.5%; positive predictive value [PPV], 24.8; negative predictive value [NPV], 99.1), 36.85 (sensitivity, 76.5%; specificity, 87.7%; PPV, 40.0; NPV, 97.2), 1.23 (sensitivity, 94.1%; specificity, 56.0%; PPV, 18.6; NPV, 98.9), and 1.98 (sensitivity, 70.6%; specificity, 80.5%; PPV, 27.9; NPV, 96.2), respectively. CONCLUSION: This study demonstrates that higher shock index, glucose/potassium ratio, and lactate levels are significantly associated with increased mortality in patients with isolated thoracic trauma. These findings suggest that these markers can be effective prognostic indicators, potentially guiding clinical decision-making and improving patient outcomes.

Background: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) carries variability in arterial flow pulsatility (AFP).Research question: What changes in cerebral and somatic oxygenation, hemodynamics, and autonomic function are associated with AFP during VA-ECMO?Methods: This is a prospective study of children on VA-ECMO undergoing neuromonitoring. AFP was quantified by arterial blood pressure pulse amplitude and subcategorized: no pulsatility (<1 mmHg), minimal pulsatility (1 to <5 mmHg), moderate pulsatility (5 to <15 mmHg) and high pulsatility (>= 15 mmHg). CVPR was assessed using the cerebral oximetry index (COx). Cerebral and somatic oxygenation was assessed using cerebral regional oximetry (rSO(2)) or peripheral oxygen saturation (SpO(2)). Autonomic function was assessed using baroreflex sensitivity (BRs), low-frequency high-frequency (LF/HF) ratio and standard deviation of heart rate R-R intervals (HRsd). Differences were assessed across AFP categories using linear mixed effects models with Tukey pairwise comparisons. Univariate logistic regression was used to explore risk of AFP with brain injuries.Results: Among fifty-three children, comparisons of moderate to high pulsatility were associated with reductions in rSO(2) (p < 0.001), SpO 2 (p = 0.005), LF/HF ratio (p = 0.028) and an increase in HRsd (p < 0.001). Reductions in BRs were observed across comparisons of none to minimal (P < 0.001) and minimal to moderate pulsatility (p = 0.004). Comparisons of no to low pulsatility were associated with reductions in BRs (p < 0.001) and ABP (p < 0.001) with increases in SpO(2) (p < 0.001) and HR (p < 0.001). Arterial ischemic stroke was associated with higher pulsatility (p = 0.0384).Conclusion: During VA-ECMO support, changes toward high AFP are associated with autonomic dysregulation and compromised cerebral and somatic tissue oxygenation.

Objectives Mild traumatic brain injury (mTBI) comprises most (70%–90%) of all pediatric head trauma cases seeking emergency care. Although most mTBI cases have normal initial head computed tomography scan, a considerable portion of the cases have intracranial imaging abnormalities on computed tomography scan. Whereas other intracranial pathological findings have been extensively studied, little is known about the clinical significance of pneumocephalus in pediatric mTBI. Methods We retrospectively identified pediatric mTBI patients with pneumocephalus using the institutional database of a large regional trauma referral center. Outcome measures were defined as clinically important TBI (ciTBI), hospitalization, intensive care unit (ICU) admission, and neurosurgical intervention. Comparisons were made between pneumocephalus and control (isolated linear fracture) groups as well as between isolated (only linear fracture and pneumocephalus) and nonisolated pneumocephalus (pneumocephalus and TBI) groups. Results Among 3524 pediatric mTBI cases, 43 cases had pneumocephalus (1.2%). Twenty-one cases (48.8%) had isolated pneumocephalus. The pneumocephalus group had higher rates of ciTBI, hospital admission, ICU admission, and neurosurgery when compared with the isolated linear fracture (control) group. The isolated pneumocephalus group had fewer ciTBI (21.1% vs 70%, P = 0.002), fewer hospitalization (23.8% vs 81.8%, P < 0.001), but similar ICU admission rates (4.8% vs 22.7%, P = 0.089) and length of hospital stay (4.0 ± 2.7 vs 3.6 ± 2.4 days, P = 0.798) in comparison to the nonisolated pneumocephalus group. None of the patients in the isolated group had neurosurgery whereas 2 patients in the nonisolated pneumocephalus group underwent surgery. Multivariable analysis revealed pneumocephalus as an independent predictor of ciTBI and hospital admission, but not ICU admission or neurosurgical intervention. Conclusion Pneumocephalus is associated with increased rates of hospitalization and ciTBI, but not ICU admission, unfavorable outcome, or neurosurgical intervention in pediatric mTBI. Although usually spontaneously resolving pathology, it may occasionally be linked with complications such as cerebrospinal fluid leakage, meningitis, and tension pneumocephalus. Therefore, careful evaluation, close observation, and early detection of complications may prevent adverse outcomes.

Objective: We aimed to investigate model-based indices of cerebrovascular dynamics after pediatric traumatic brain injury (TBI) using transcranial Doppler ultrasound (TCD) integrated into multimodality neurologic monitoring (MMM).Methods: We performed a retrospective analysis of pediatric TBI patients undergoing TCD integrated into MMM. Classic TCD characteristics included pulsatility indices and systolic, diastolic and mean flow velocities of the bilateral middle cerebral arteries. Model-based indices of cerebrovascular dynamics included the mean velocity index (Mx), compliance of the cerebrovascular bed (Ca), compliance of the cerebrospinal space (Ci), arterial time constant (TAU), critical closing pressure (CrCP) and diastolic closing margin (DCM). Classic TCD characteristics and model-based indices of cerebrovascular dynamics were investigated in relation to functional outcomes and intracranial pressure (ICP) using generalized estimating equations with repeated measures. Functional outcomes were assessed using the Glasgow Outcome Scale–Extended Pediatrics score (GOSE-Peds) at 12 months, post-injury.Results: Seventy-two separate TCD studies were performed on twenty-five pediatric TBI patients. We identified that reduced Ci (estimate −5.986, p = 0.0309), increased CrCP (estimate 0.081, p < 0.0001) and reduced DCM (estimate −0.057, p = 0.0179) were associated with higher GOSE-Peds scores, suggestive of unfavorable outcome. We identified that increased CrCP (estimate 0.900, p < 0.001) and reduced DCM (estimate −0.549, p < 0.0001) were associated with increased ICP.Conclusion: In an exploratory analysis of pediatric TBI patients, increased CrCP and reduced DCM and Ci are associated with unfavorable outcomes, and increased CrCP and reduced DCM are associated with increased ICP. Prospective work with larger cohorts is needed to further validate the clinical utility of these features.

Background Extracorporeal membrane oxygenation (ECMO) provides lifesaving support to critically ill patients who experience refractory cardiopulmonary failure but carries a high risk for acute brain injury. We aimed to identify characteristics reflecting acute brain injury in children requiring ECMO support. Methods This is a prospective observational study from 2019 to 2022 of pediatric ECMO patients undergoing neuromonitoring, including continuous electroencephalography, cerebral oximetry, and transcranial Doppler ultrasound (TCD). The primary outcome was acute brain injury. Clinical and neuromonitoring characteristics were collected. Multivariate logistic regression was implemented to model odds ratios (ORs) and identify the combined characteristics that best discriminate risk of acute brain injury using the area under the receiver operating characteristic curve. Results Seventy-five pediatric patients requiring ECMO support were enrolled in this study, and 62 underwent neuroimaging or autopsy evaluations. Of these 62 patients, 19 experienced acute brain injury (30.6%), including seven (36.8%) with arterial ischemic stroke, four (21.1%) with hemorrhagic stroke, seven with hypoxic-ischemic brain injury (36.8%), and one (5.3%) with both arterial ischemic stroke and hypoxic-ischemic brain injury. A univariate analysis demonstrated acute brain injury to be associated with maximum hourly seizure burden ( p = 0.021), electroencephalographic suppression percentage ( p = 0.022), increased interhemispheric differences in electroencephalographic total power ( p = 0.023) and amplitude ( p = 0.017), and increased differences in TCD Thrombolysis in Brain Ischemia (TIBI) scores between bilateral middle cerebral arteries ( p = 0.023). Best subset model selection identified increased seizure burden (OR = 2.07, partial R 2 = 0.48, p = 0.013), increased quantitative electroencephalographic interhemispheric amplitude differences (OR = 2.41, partial R 2 = 0.48, p = 0.013), and increased interhemispheric TCD TIBI score differences (OR = 4.66, partial R 2 = 0.49, p = 0.006) to be independently associated with acute brain injury (area under the receiver operating characteristic curve = 0.92). Conclusions Increased seizure burden and increased interhemispheric differences in both quantitative electroencephalographic amplitude and TCD MCA TIBI scores are independently associated with acute brain injury in children undergoing ECMO support.

Stroke in children is more common than is often realised; there are numerous potential causes, including carotid artery injury resulting from minor head or neck trauma, as well as genetic conditions associated with thrombophilia. A 13-year-old boy suffered an arterial ischaemic stroke (AIS) secondary to dissection of the left internal carotid artery (ICA) after he headed the ball during a game of football. He presented with generalised tonic-clonic seizure, loss of consciousness, right-sided hemiplegia and aphasia. Neuroradiological imaging showed left caudate, putaminal and posterior insular ischaemic infarct secondary to complete occlusion of the left ICA and accompanying partial left middle cerebral artery occlusion. He was treated with anticoagulant and anti-aggregant agents. Rarely, minor head trauma can result in internal carotid artery dissection, thrombus formation and arterial occlusion, leading to arterial ischaemic stroke. Prompt diagnosis and management are crucial to achieve a good neurological outcome.

Mild traumatic brain injury (mTBI) is a global public health problem and its current management is limited to rest and symptom management. Despite frequent use of drugs for symptom control, there is a lack of consensus on the optimal pharmacological management of post-concussive symptoms. We reviewed the relevant literature to compile the evidence about the pharmaceutical management of pediatric mTBI. We performed a systematic review of the literature available in PubMed, Cochrane CENTRAL, and ClinicalTrials.Gov as well as through citation tracing. A modified PICO framework was used for the construction of search strategy and eligibility criteria. Risk of bias was assessed using RoB-2 tool for randomized and ROBINS-I for non-randomized studies. A total of 6260 articles were screened for eligibility. After exclusions, a total of 88 articles received full text review. A total of 15 reports representing 13 studies (5 randomized clinical trials, 1 prospective randomized cohort study, 1 prospective cohort study, and 6 retrospective cohort studies) met the eligibility criteria and were included in the review. We identified 16 pharmacological interventions in a total of 931 pediatric patients with mTBI. Amytriptiline (n = 4), ondansetron (n = 3), melatonin (n = 3), metoclopramide (n = 2), magnesium (n = 2), and topiramate (n = 2) were investigated in multiple studies. All RCTs were relatively of small size (n ≤ 33/group). The available evidence supporting pharmacological intervention in pediatric mild traumatic brain injury is scarce. We propose a framework to facilitate future collaborative research efforts to test and validate various pharmacological interventions for acute and persistent post-concussive symptoms in children.

Çocuk Yoğun Bakım Ünitesi ve Ekibi Süleyman BAYRAKTAR Kritik Çocuk Hastaya Yaklaşım Metin KARABÖCÜOĞLU Yoğun Bakım Hastasında Sıvı ve Elektrolit Tedavisi Ahmet NAYIR, Zeynep YÜRÜK YILDIRI Çocuk Yoğun Bakım Hastalarında Beslenme Bülent KARAPINAR, Pınar YAZICI İmmün Beslenme Hasan AĞIN, Gökhan CEYLAN Kalp Akciğer Etkileşimi Agop ÇITAK Hemodinamik Monitörizasyon Sultan GÖNCÜ, Benan BAYRAKCI Şok ve Dolaşım Desteği Nilgün ERKEK Septik Şok ve Tedavisi Esra ŞEVKETOĞLU Çoğul Organ Yetmezliği Sendromu Nilüfer YALINDAĞ Yoğun Bakımda Disritmilerin Tedavisi Arda SAYGILI Akut Konjestif Kalp Yetersizliği Oğuz DURSUN Çocuk Kalp Cerrahisi Sonrası Yoğun Bakım Arda SAYGILI Akut Solunum Yetmezliği ve Tedavisi Tanıl KENDİRLİ Yoğun Bakım Ünitelerinde Hastane Enfeksiyonları Tanıl KENDİRLİ İmmünkompromize Hastanın Çocuk Yoğun Bakım Ünitesinde Değerlendirilmesi Hasan AĞIN, Rana İŞGÜDER Komadaki Hastaya Yaklaşım Agop ÇITAK Kafa İçi Basınç Artışı Sendromu Ali Ertuğ ARSLANKÖYLÜ Status Epileptikus ve Tedavisi Murat DUMAN, Emel ULUSOY Kardiyopulmoner Arrest Sonrası Hipoksik İskemik Ensefalopati Damla HANALİOĞLU, Pelin CENGİZ Beyin Ölümü ve Donör Yönetimi Zeynelabidin ÖZTÜRK, Benan BAYRAKCI Kritik Hasta Çocuklarda Akut Böbrek Yetersizliği ve Renal Destek Sistemleri Demet DEMİRKOL Akut Karaciğer Yetmezliği ve Tedavisi Nurettin Onur KUTLU Mekanik Ventilasyon Temel İlkeleri Tolga F. KÖROĞLU Mekanik Ventilasyon Endikasyonları, Yönetimi ve Uygulamaları Dinçer YILDIZDAŞ, Faruk EKİNCİ Hipoksik Solunum Yetersizliğinde Mekanik Ventilasyon Tolga F. KÖROĞLU Hiperkapneik Solunum Yetersizliği ve Tedavisi Demet DEMİRKOL Mekanik Ventilasyon Sırasında Monitorizasyon Başak Nur AKYILDIZ Mekanik Ventilasyondan Ayırma Tanıl KENDİRLİ Noninvazif Mekanik Ventilasyon Bülent KARAPINAR, Pınar YAZICI Çocuk Yoğun Bakım Ünitelerinde Sedasyon ve Analjezi Dinçer YILDIZDAŞ Çoğul Travmalı Hastaya Yaklaşım Murat DUMAN, Hale ÇİTLENBİK İnhalasyon Yaralanmaları Ayşe Berna ANIL Yanık Ayşe Berna ANIL Çocukluk Döneminde Zehirlenme Olgularına Genel Yaklaşım Hayri Levent YILMAZ Sık Görülen Özgül Zehirlenmelere Yaklaşım Hayri Levent YILMAZ Çocuklarda İntraabdominal Hipertansiyon ve Abdominal Kompartman Sendromu Özden ÖZGÜR HOROZ

BACKGROUND: The necessity of computed tomography (CT) has been questioned in pediatric mild traumatic brain injury (mTBI) because of concerns related to radiation exposure. Distinguishing patients with lower and higher risk of clinically important TBI (ciTBI) is paramount to the optimal management of these patients. OBJECTIVE: This study aimed to analyze the imaging predictors of ciTBI and develop an algorithm to identify patients at low and high risk for ciTBI to inform clinical decision making using a large single-center cohort of pediatric patients with mTBI. METHODS: We retrospectively identified pediatric patients with mTBI with repeat CT within 48 hours of injury using an institutional database. RESULTS: Among 3867 pediatric patients, 219 patients with mTBI with repeat CT were included. Thirty-eight had ciTBI (17%), 16 (7%) required intensive care unit admission, and 6 (3%) underwent surgery. Median time interval between initial and repeat CT was 7 hours (range, 4-10). Clinical worsening and radiologic progression were evident in 36 (16%) and 24 (11%) patients, respectively. Multivariate analysis showed that 5 pathologic findings (depressed skull fracture, pneumocephalus, epidural hematoma, subdural hematoma, and contusion) on initial CT and radiologic progression on repeat CT were independent predictors of ciTBI. A new scoring system based on these 5 factors on initial CT (IniCT [Initial CT scoring system] score) had excellent discrimination for ciTBI, need for intensive care unit admission, and neurosurgery (area under the curve >0.8). CONCLUSIONS: The IniCT scoring system can successfully differentiate low-risk and high-risk patients based on initial CT scan. Zero score can eliminate the need for a routine repeat CT, whereas scores >= 2 should prompt serial neurologic examinations and/or repeat CT depending on the clinical situation.

OBJECTIVE:Unscheduled return visits to the emergency department (unscheduled RTED) increase both the workload and overcrowding in the emergency department. The aim in the present study is to identify the patient groups that require more careful and closer follow-up to reduce the rates of unscheduled RTED and hospital admissions after a return visit.METHODS:Among the patients admitted to the emergency department of our hospital between 2016 and 2017, those who made an unscheduled RTED within 72 hours after their first visit to the emergency department were evaluated retrospectively.RESULTS:Of the 137,787 eligible children, 3294 (2.8%) made unscheduled RTEDs within 72 hours. The median age was 28 months, and 1848 (57.6%) were male patients. The admission rate at the return visit was significantly higher among children younger than 2 years, in the patients presenting with respiratory complaints and severe acute conditions, and in those who presented to the emergency department for the first time during the department's busiest hours. The risk of admission upon a return visit to the emergency department was 2.7 times higher in the male sex, 5.4 times higher in children younger than 2 years, 5.9 times higher in patients with respiratory complaints, 4.9 times higher in patients with gastrointestinal tract complaints, and 27,000 times higher in patients with severe acute conditions.CONCLUSIONS:Unscheduled RTED and hospitalization rates can be reduced with more careful evaluation of young children, patients with respiratory and gastrointestinal complaints and those who apply during emergency department busiest hours.

OBJECTIVE:The coronavirus disease 2019 pandemic affected the healthcare systems worldwide. In this study, we aimed to examine the impact of the coronavirus disease 2019 pandemic on injury-related visits.MATERIALS AND METHODS:We conducted a retrospective analysis of 7648 injury-related pediatric emergency department visits between March 11 and June 30, 2018, 2019, and 2020, and com- pared the total number of visits, triage levels, distributions of injury mechanisms, and admission rates during the pandemic in 2020 to the same period in 2018 and 2019.RESULTS:In the first 4 months of the pandemic, there was a 69.5% drop in all pediatric emer- gency department visits compared to the previous 2 years. Despite this decrease, the propor- tion of injury-related pediatric emergency department visits increased from 14% to 20.9% in 2020 (P < .001). There was a 3.8% increase in the frequencies of patients with high triage acuity levels (T1, T2, and T3) and a 3.8% decrease in patients with low triage acuity levels (P < .001). The domestic injury rate increased from 40% to 60% during the pandemic period (P < .001). Hospitalization rates increased from 6% to 11.5% and admission to intensive care units increased from 0.9% to 3.3%. The differences were statistically significant (P < .001). Visits due to burn increased from 2.7% to 5.2% (P < .001), poisoning from 3.4% to 5.5% (P < .001), bicycle accidents from 3.3% to 6.8% (P < .001), while injuries due to motor vehicle accidents decreased from 2.6% to 1.3% (P = .004) and sports injuries decreased from 8% to 2.1% (P < .001).CONCLUSION:This study revealed that despite the significant decrease in total pediatric emer- gency department visits, percentages of injury-related visits increased during the pandemic.