Causes and clinical features of children with traumatic brain injury: a retrospective analysis of 126 cases / 中国当代儿科杂志

OBJECTIVE@#To investigate the causes and clinical features of children with traumatic brain injury (TBI) who need hospitalization or emergency observation.@*METHODS@#A retrospective analysis was performed for the clinical data of 126 children with TBI who were admitted to the emergency department from January 1, 2014 to August 31, 2016, including causes of injury and clinical features.@*RESULTS@#Of the 126 children, there were 95 boys and 31 girls, with a mean age of 2.8 years (range 0.8-5.5 years). The children aged <1 year accounted for 38.1% (48/126), and 26 children died. The two most common types of TBI were epidural hematoma (54.0%) and subarachnoid hemorrhage (50.8%). Of the 126 children, 83 (65.9%) had a Glasgow Coma Scale score of ≤8 within 24 hours after admission. There were different causes of TBI and places where TBI occurred in different age groups. The two leading causes of TBI were falls (51.6%) and road traffic injuries (42.9%). Compared with those in the other age groups, the children in the age <1 year group were most likely to experience injury due to falls (46%; P=0.023). Thirty-five percent of all TBI due to road traffic injuries occurred in the children aged 3-6 years (P<0.001). Most TBI cases occurred at home (47.6%) or on roads/streets (45.2%). Among those who experienced TBI at home, the children aged <1 year accounted for the highest proportion of 48% (P=0.002), and 53% of the patients aged 3-6 years experienced TBI on roads/streets. The most common cause of death in children with TBI was road traffic injury, which accounted for 69%. Among those who died, the children aged <1 year accounted for the highest proportion (62%).@*CONCLUSIONS@#There are different causes of TBI and places where TBI occurs in different age groups. Among children with TBI, the children aged <1 year account for the highest proportion and have the highest number of deaths, with falls at home as the most common cause of TBI. Children aged 3-6 years tend to suffer TBI due to road traffic injury. Road traffic injury is the leading cause of death.

Warfarin and aspirin combination therapy for giant coronary artery aneurysm secondary to Kawasaki disease / 中华实用儿科临床杂志

Objective To explore whether the warfarin and aspirin combination therapy can prevent cardiovascular events in patients with giant coronary artery aneurysm (GCAA) caused by Kawasaki disease (KD).Methods Children who had been diagnosed as GCAA secondary to KD in Beijing Children's Hospital Affiliated to Capital Medical University between Jan.1998 and Aug.2012 were enrolled in this study.They were divided into the warfarin plus aspirin group (combination group) and aspirin group.The combination group used the therapy of warfarin and small dose aspirin in the long-term anticoagulation treatment,while the aspirin group used small dosage of aspirin without warfarin.Both groups were followed at the time points of 2nd week,1st month,3rd month,6th month,and 1st year after discharge of the acute stage.Then these children were followed every 6 months.Data on each followed-up included clinical manifestations,coronary artery aneurysm recovery situation and complications.Results (1) The onset age of GCAA caused by KD ranged from 3 months to 13 years and 3 months.Infants who were ≤ 1 year old and children who were ≥5 years old were more susceptible to this disease,their proportion were both 23.1％ . (2) The distribution of GCAA in both groups were similar.GCAA most commonly occurred in the right coronary artery,then the left anterior descending coronary artery,and then the main trunk of left coronary artery,the left circumflex artery was rarely affected.(3) Coronary artery aneurysm in 17 cases(53.1％) retracted in the warfarin combined with aspirin group,while 5 cases(41.7％) in the aspirin group.Fifteen cases(46.9％) in the combination group hadn't obvious change,while the aspirin group got 7 cases (58.3 ％).(4) During the follow-up,2 children (6.3 ％) complicated with intracoronary thromboses in the combination group,while 3 cases(25.0％) in the aspirin group.One case(3.1％) in the combination group suffered myocardial infarction,while 3 cases (25.0％) in the asprin group.Two cases (16.7 ％) in the aspirin group died,while none in the combination group.Coronary artery stenosis occurred in 2 cases (16.7％) in the aspirin group,while 1 case (3.1％) in the combination group.One child had coronary artery occlusion in the aspirin group,while none in the combination group.(5)The combination group had 1 case of serious bleeding event,subarachnoid hemorrhage.In addition,there were 8 cases of nasal bleeding,a total of 19 person-time.There was no serious bleeding event in the aspirin group,only 3 person-time small mount of nasal bleeding.Conclusions Althought warfarin plus aspirin therapy for the long-term anticoagulation treatment in GCAA caused by KD can not affect the retraction of GCAA,it may decrease the incidence of thrombosis,myocardial infarction and mortality.Bleeding complication is more common during the application of wafarin.Therefore the dose of warfarin should be tailored in various children according to the clinical situation,and bleeding complication should be monitored.