[Show abstract][Hide abstract] ABSTRACT: OBJECTIVES: This study aimed to describe the determinants of the severity and type of injuries sustained by children hurt in off-road vehicle (ORV) accidents. METHODS: This was a retrospective clinical study for which data were obtained from the trauma database at the Children's Hospital at Westmead covering the 10-year period between January 1, 1998, and December 31, 2007. Data points collected included age, sex, Injury Severity Score (ISS), body region injured, type of vehicle, accident setting, mechanism of injury, estimated speed, position of the rider, use of a helmet and/or protective clothing, and hospital length of stay. The study end points were determinants of injury severity and type. Statistical analysis of the collected data was done with the standard statistical software package, SPSS. RESULTS: A total of 288 children (242 male [84%] and 46 female [16%] patients) presented for ORV-related trauma. Helmets significantly diminished the chance of sustaining a head injury occasioning a skull fracture. Jumping was associated with increased ISS and a higher chance of sustaining an abdominal and/or thoracic injury. Older children were more likely to sustain pelvic and spinal injures, be injured while traveling at high speed, and be injured while going over a jump. Mean ISS was significantly lower if trauma was sustained while riding a mini motorcyle in any setting and any ORV at home. CONCLUSIONS: Further research (prospective, federal, and multi-institutional) is needed with a view to optimizing training schedules, rules, regulations, and licensing requirements for pediatric ORV riders.
Pediatric emergency care 11/2012; 28(12). DOI:10.1097/PEC.0b013e318276b0d2 · 0.92 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Priapism is a sustained erection that is maintained for over 4 hours in the absence of sexual stimulation [Postgrad Med J. 2006;82(964):89-94; J Urol. 2003;170:1318-1324]. Distinction is made between low- and high-flow variants [J Urol. 2003;170:1318-1324; Cardiovasc Intervent Radiol. 2002;25(4):326-329]. Low-flow priapism (LFP) and acute appendicitis are rarely associated. Including ours, there are 4 cases reported in the literature, all of which have occurred in children. The complications of LFP are potentially serious and include loss of the phallus altogether. Treatment of LFP is should be prompt and is the same irrespective of the etiology.
Journal of Pediatric Surgery 12/2008; 43(11):2091-5. DOI:10.1016/j.jpedsurg.2008.06.015 · 1.31 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: High-flow priapism is an uncommon entity in the pediatric and adolescent population. It is usually caused by perineal trauma. Here we describe the experience of our institution in this condition over the past 10 years, the various treatment options available, and the successful application of super-selective angiographic embolization as our treatment modality of choice. Included here is the case of a 4-year-old boy (case 3) who, to our knowledge, is the youngest patient described with this condition in the literature.
Journal of Pediatric Surgery 11/2008; 43(10):1898-901. DOI:10.1016/j.jpedsurg.2008.05.027 · 1.31 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Urethrocutaneous fistulas complicating hypospadias repair appear a common problem. There appears less data in the literature regarding the risk and management of recurrent fistulas. A retrospective review of urethrocutaneous fistulas complicating hypospadias repair was performed to evaluate their aetiology, management and outcome. Between 1993 and 2003, 1,753 patients had a hypospadias repair at our institution. Overall 123 (7%) boys developed a fistula, although detailed information was available on 117 patients only. Median age was 3.5 years at the time of fistula repair; 13% had anterior, 57% had middle and 30% had posterior hypospadias. The most common primary surgical procedure was a Durham Smith two-stage repair in 29% (n = 34), followed by a Tubularised Incised Plate urethroplasty in 19% (n = 22) and an Onlay in 14% (n = 16). Thirty-one (27%) patients developed a recurrent fistula, 9 (29%) of which recurred following a second repair. None recurred after a third repair. The risk of a recurrent fistula after an initial distal fistula repair was 12.5% and after a posterior fistula was 62% (chi(2) = 15.4, P = 0.001). Use of a stent, suture type, numbers of fistula and closure attempts did not influence the recurrence rate. Undiagnosed distal obstruction was thought to be related to 27 of 117 first fistula repairs (23%) and 4 of 31 second fistula repairs (13%). The risk of recurrent urethrocutaneous fistula was increased in those boys with a posterior fistula, following a simple repair or when there was evidence of distal urethral obstruction.
Pediatric Surgery International 10/2008; 24(9):1047-51. DOI:10.1007/s00383-008-2202-0 · 1.06 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Balanitis xerotica obliterans (BXO) is the most common cause of pathological phimosis in boys. Presented here is the case of a previously well 13-year-old boy who developed obstructive renal impairment (serum creatinine = 190 micromol/l) at least in part from phimosis due to BXO. A circumcision and, 2.5 months later, meatal dilatation were done. Nine months after his initial presentation, his serum creatinine returned to a permanently elevated nadir of 119 mumol/l. Presentation with the complications of phimosis can be delayed in teenage boys because they may feel embarrassed to come forward. Circumcision remains the definitive treatment of BXO induced phimosis though if the penile meatus is involved, more complex surgery is sometimes required. Topical steroids are useful for residual disease. Follow-up is very important due to the frequent involvement of the skin of the glans. In the very long term there is an increased chance of penile malignancy, which can occur even after circumcision.
Pediatric Surgery International 07/2008; 24(8):961-4. DOI:10.1007/s00383-008-2189-6 · 1.06 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Eight children suffered drowning or near-drowning in Sydney pools over an 11-day period in January 2007. Four received basic life support (BLS) within 5 minutes of immersion and survived with good functional neurological outcomes. The other four were not discovered for >or= 5 minutes and all died. This cluster serves as a reminder that timely effective bystander BLS is crucial to survival and good clinical outcomes in near-drowning episodes.
The Medical journal of Australia 04/2008; 188(8):484-5. · 3.79 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To study the diagnostic accuracy and clinical efficacy of surgeon-performed focused abdominal sonography (FAST) in paediatric blunt abdominal trauma (BAT).
This was a prospective, single blinded study conducted at The Children's Hospital at Westmead Sydney (CHW). All patients with BAT that justified a trauma call activated on presentation to the Emergency Department (ED) had a FAST performed by the Trauma Fellow. The attending surgical team was blinded to the result of the FAST. An independent radiologist reviewed the FAST pictures, and the findings were compared with computerised tomography (CT), ultrasound (US), laparotomy and the clinical outcome of the patient. Sensitivity, specificity and predictive values were calculated.
A total of 85 patients (39 M; 26 F) were enrolled in the study between February 2002 and January 2003. The age ranged between 4 months and 16 years. The mean Injury Severity Score (ISS) was 6 (range 1-38). FAST was performed in a mean time of 3 min. Inter-rater agreement was 96%. FAST was positive in nine as confirmed by a CT scan of the abdomen. Three patients underwent laparotomy, two for bowel injuries and one for a Grade III liver laceration. Of the remaining 76, 19 had a CT, which showed evidence of intra-abdominal injury in seven patients. There were two false negative studies resulting in a sensitivity of 81%, specificity of 100%, negative predictive value of 97%, positive predictive value of 100% and an accuracy of 97%.
Surgeon-performed FAST for BAT was safe and accurate with a high specificity. It would seem a potentially valuable tool in the evaluation of paediatric blunt trauma victims for free fluid within the peritoneal cavity.
[Show abstract][Hide abstract] ABSTRACT: Diaphragmatic injuries following blunt trauma are rare. From January 1988 to February 2002 eight children were treated at the Children's Hospital at Westmead for diaphragmatic injury. Male to female ration was 5:3. Motor vehicle crashes were the most common cause. The injury was left-sided in four, right sided in three and central in one. Initial plain radiograph and computerised tomography detected the injury in 50% of cases. Laparotomy, contrast study and autopsy identified the rupture in one each. Associated injuries were present in all cases. Seven children had laparotomy and repair of the diaphragmatic rupture. The commonest site of rupture was posterolateral (37.5%). Diagnosis was delayed in two cases. There were two deaths (25% mortality) in the series, both due to associated injuries. Although rare, diaphragmatic rupture must be considered in any child with thoracoabdominal injury. Diagnosis may be difficult and require extensive investigation. Mortality usually results from associated injuries.
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to determine the etiology, associated injuries, and outcome of children with pancreatic injuries.
A retrospective review was conducted of children under 16 years with pancreatic trauma admitted to the Children's Hospital at Westmead (CHW) from January 1983 to September 2002. Deaths were reported to the New South Wales Paediatric Trauma Death Registry (State Registry) from January 1988 to September 2002.
Sixty-five cases were identified: 46 patients were admitted to CHW, and 22 deaths were reported to the State Registry (including 3 deaths at CHW). The median age was 6 years (range, 1 to 14 years). Boys accounted for 60% (n = 40) of cases, decreasing to 50% (n = 11) of those that died. Motor vehicle injuries (MVI) were the most common mechanism, accounting for 40% of survivors and 77% of those who died. Children were restrained incorrectly in 48% of all cases and in 67% of those who died. Significantly more children who died had head, chest, and abdominal visceral injuries, compared with those who survived. Death occurred as a result of head injuries in 68%, with only 3 deaths directly attributed to pancreatico-duodenal injuries.
Pancreatic injuries remain uncommon in children. The most frequent mechanism was MVI, with incorrect use of passenger restraints an important contributing factor. Whereas mortality was mainly caused by other injuries, 3 deaths were directly attributable to pancreato-duodenal trauma.
Journal of Pediatric Surgery 02/2004; 39(1):96-9. DOI:10.1016/j.jpedsurg.2003.09.011 · 1.31 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To characterize children aged under 5 years who present to paediatricians following near-drowning and the circumstances surrounding the event, identify high-risk groups and document short-term outcome.
Monthly notifications to the Australian Paediatric Surveillance Unit (an active, national surveillance system) between 1994 and 1996. Collection of additional case information from reporting doctors by postal questionnaire.
All 169 reported cases of near-drowning were admitted to hospital (mean (SD) stay 6 (17) days) and 15% required intensive care (mean (SD) stay 19 (32) days). The mean (SD) age for near drowning was 26 (13) months and 22% children were aged between 12 and 18 months. Males predominated (1.6:1) and 69 (41%) of episodes occurred in summer (December - February). The majority (82%) of near-drownings occurred in the child's home, usually in a swimming pool or bath. Children who nearly drowned at home were significantly younger than those who nearly drowned in natural waterways or public pools. Neurological damage at discharge following near-drowning was reported in 7%.
Children reported in this national case series represent the severe end of the spectrum of those who nearly drown, as indicated by their presentation to a paediatrician, universal hospitalization and adverse neurological outcome. The home is the site of most near-drownings and males and toddlers were at particular risk. Unimpeded access to pools and lack of supervision were identified as potentially modifiable factors for prevention. The study suggests the need for additional community education regarding the risks of near-drowning and for further research on long-term neuro-developmental outcomes following near-drowning.
Journal of Paediatrics and Child Health 09/2003; 39(6):446-50. DOI:10.1046/j.1440-1754.2003.00186.x · 1.19 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to describe what surgical procedures are performed in the neonatal period in New South Wales (NSW) and where they are performed.
Population-based descriptive study was conducted in NSW in a 2-year period from July 1, 1996 to June 30, 1998, inclusive, using information from the NSW Health Department's Inpatient Statistics Collection. All neonates undergoing major surgery (excluding circumcisions) in NSW.
In the first 4 weeks of life, 990 (0.6%) neonates underwent surgery. The most common surgical procedures were gastrointestinal, cardiovascular, hernia, genitourinary, and neurosurgical. Frenotomy accounted for 5% of all surgical procedures. Whereas 75% of neonatal surgery (including 88% of gastrointestinal and 97% cardiovascular surgery) occurs in children's hospitals, only 13% of the babies requiring surgery are born in the co-located obstetric hospitals. Perinatal centers accounted for 5.3% of surgery; urban hospitals for 8.4%; rural hospitals, 5.5%, and private hospitals, 6.4%. The mortality rate in the neonatal period was 3.0% overall.
This is the first review of major neonatal surgery in Australia and provides baseline data for future comparisons. Whereas most neonates had surgery in a children's hospital, few of them were born in the most appropriate place, the co-located obstetric hospital. Parents should be informed of the level of institutional surgical expertise and be involved in the decision-making regarding the place of surgery for their infant. Parents and children have a right to expect the best possible results.
Journal of Pediatric Surgery 08/2003; 38(7):1025-31. DOI:10.1016/S0022-3468(03)00184-2 · 1.31 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Mutations or deletions involving ZFHX1B (previously SIP1) have recently been found to cause one form of syndromic Hirschsprung disease (HSCR), associated with microcephaly, mental retardation, and distinctive facial features. Patients with the characteristic facial phenotype and severe mental retardation, but without HSCR, have now also been shown to have mutations in this gene. Mutations of ZFHX1B are frequently associated with other congenital anomalies, including congenital heart disease, hypospadias, renal tract anomalies, and agenesis of the corpus callosum (ACC). We present the clinical data and mutation analysis results from a series of 23 patients with this clinical syndrome, of whom 21 have proven ZFHX1B mutations or deletions (15 previously unpublished). Two patients with the typical features (one with and one without HSCR) did not have detectable abnormalities of ZFHX1B. We emphasize that this syndrome can be recognized by the facial phenotype in the absence of either HSCR or other congenital anomalies, and needs to be considered in the differential diagnosis of dysmorphism with severe mental retardation +/- epilepsy.
American Journal of Medical Genetics Part A 06/2003; 119A(3):257-65. DOI:10.1002/ajmg.a.20053 · 2.05 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To determine the frequency, management and outcome of penetrating trauma in children.
A retrospective review of penetrating injuries in children under 16 years of age admitted to the Children's Hospital at Westmead (CHW), and deaths reported to the New South Wales Paediatric Trauma Death (NPTD) Registry, from January 1988 to December 2000. Patient details, circumstances of trauma, injuries identified, management and outcome were recorded.
Thirty-four children were admitted to the CHW with penetrating injuries during the 13-year period. This represented 0.2% of all trauma admissions, but 3% of those children with major trauma. The injury typically involved a male, school-age child that fell onto a sharp object or was assaulted with a knife or firearm by a parent or person known to them. Twenty-five children (75%) required operative intervention for their injuries and 14 survivors (42%) suffered long-term morbidity. Thirty children were reported to the NPTD Registry over the same interval, accounting for 2.3% of all trauma deaths in New South Wales. Of these, a significant minority was injured by falls from a mower or a tractor towing a machine with blades.
Penetrating injuries are uncommon, but cause serious injury in children. There are two clear groups: (i) those dead at the scene or moribund on arrival, in whom prevention must be the main aim; and (ii) those with stable vital signs. Penetrating wounds should be explored in the operating theatre to exclude major injury. Young children should not ride on mowers or tractors.
Journal of Paediatrics and Child Health 11/2002; 38(5):487-91. DOI:10.1046/j.1440-1754.2002.00034.x · 1.19 Impact Factor