A review of blood transfusions in a trauma unit for young children

Background. Trauma is the leading cause of mortality and morbidity worldwide. Blood transfusions play an incremental role in the acute phase, yet practice varies owing to variations in transfusion thresholds and concerns about potential complications, especially in children.Objectives. To evaluate protocol adherence to blood transfusion thresholds in paediatric trauma patients and determine the degree of blood product wastage, as defined by discarded units.Methods. A retrospective, descriptive study of trauma patients (age 0 - 13 years) who received a blood transfusion in the trauma unit at Red Cross War Memorial Children's Hospital, Cape Town, South Africa, over a 5.5-year period (1 January 2009 - 1 July 2014). Haemoglobin (Hb) transfusion thresholds were defined as 10 g/dL for neurotrauma patients and patients requiring skin grafting or a musculocutaneous flap (group 1). All other trauma patients had an Hb transfusion threshold of 7 g/dL (group 2).Results. A total of 144 patients were included (mean age 5.2 years (standard deviation (SD) 3.3), 68.1% male). The mean Hb increase after transfusion was 3.5 g/dL (SD 1.7). Adherence to the transfusion Hb threshold protocol was 96.7% for group 1 v. 34.0% for group 2. No complications were reported. Average blood wastage was 3.5 units per year during the study period.Conclusions. Adherence to paediatric blood transfusion protocol was low in the Hb threshold group <7 g/dL. However, transfusion-related complications and wastage were minimal. Further prospective research is required to determine optimal blood transfusion guidelines for paediatric trauma patients

Fenômeno lúcio. Relato de um caso exuberante com excelente resposta ao tratamento com poliquimioterapia multibacilar

O Fenômeno de Lúcio (FL) representa uma reação cutânea necrosante grave, que pode ocorrer na Hanseníase de Lúcio e em outras formas de Hanseníase Virchowiana. Manifesta-se 3-4 anos após o início da doença e é mais comum em pacientes não tratados ou recebendo dose inadequada de tratamento. Caracteriza-se por surtos de máculas eritematosas, ligeiramente infiltradas, que evoluem com necrose central e posterior ulceração. Sua fisiopatogenia é ainda desconhecida, porém é consenso que se trata fundamentalmente de um processo trombótico-oclusivo. Na histologia observa-se trombose de pequenos vasos da derme superior e média, resultando em ulceração da epiderme, infiltrado inflamatório com histiócitos espumosos, e numerosos bacilos, inclusive na parede dos vasos.

Dog Bites to the Head; Neck and Face in Children

Dog bites are a poorly understood and complex public health problem. Children are most frequently the victims of dog bites and the face is often the favoured target. A review of dog bite wounds in small children presenting to the Red Cross War Memorial Children's Hospital was carried out over a period of 13.5 years (1991-2004). One thousand eight hundred and seventy-one dog bite wounds were admitted from a total of 125;677 patients treated. From 1;871 patients presenting with dog bite injuries; we identified 596 children who sustained injuries to the head; face or neck. Dog bites to the head; face or neck were responsible for 0.5of all trauma unit presentations and 32of all dog bite injuries. The mean age of the children was 5.1 years. Male children accounted for 68of the patients. The peak incidence was noted in children aged 2 to 4 years old. One hundred and seventy-two (29) bites occurred between the summer months of December and February. Two hundred and forty-nine (42) patients presented to hospital between the hours of 12:00 and 18:00 hours and 275 (46) children presented between 18:00 and 0:00 hours. A large proportion of all attacks occurred either inside or outside the victim's own home and at the home of friends or family. Superficial injuries were treated with wound cleaning; suturing and dressing. There were no fatalities. Dog bites are relatively common in small children; but do not represent a major cause of morbidity and mortality

Fracture Patterns in Non-Accidentally Injured Children at the Red Cross Children's Hospital

Background: Unexplained fractures in infants and children often suggest abuse. The fracture patterns with high specificity for abuse are well documented; however; in practice these patterns occur infrequently and abused children may present with a wide spectrum of bony injuries. The Child Accident Prevention Foundation of South Africa (CAPFSA) keeps a database of children treated at the Red Cross War Memorial Children's Hospital (RXH) in Cape Town. Methods: The medical records of all children admitted between January 1991 and October 2005 were reviewed and children with fractures resulting from non-accidental injury (NAI) were included in the study. Results: During the 14-year study period; 99586 trauma patients were treated at RXH; of which 1037 (1.04) were diagnosed with non-accidental injury. The majority was male (64). An the average age was 44.8 months. Of the 1037 patients diagnosed with NAI; 121 (11.7) sustained a total of 149 fractures; 21 (17.3) with multiple fractures (16 had 2 fractures; 3 had 3 fractures and 2 had 4 fractures). The head and neck was the most frequently fractured anatomical area (53); followed by the upper limb (24) and lower limb (18). Only 7 fractures of the trunk were seen. Children sustaining fractures of the head and neck were significantly younger than those sustaining fractures to other areas. Discussion: Although the established consensus on fracture patterns in NAI is that long bone fractures are the most frequently experienced in clinical practice; the principal finding of our study was that skull fractures were considerably more common; nearly 40of all fractures were skull fractures. Skull fractures were associated with violent injury; approximately one-third were reported to have been inflicted with an implement/weapon and one-quarter of these children had multiple fractures at the time of presentation. This underlines the importance of local studies; as socio-cultural issues underpin many of the aetiological factors related to disease burden in general; and to child abuse in particular

A prospective study of significant non-fatal injuries in small children in Cape Town : lessons for prevention

Paediatric trauma is the leading cause of death in the 5-14 year-old age group in South Africa and elsewhere in the world; with attendant considerable morbidity. This prospective study analyzed 100 consecutive children (under the age of 12 years old) presenting with injuries requiring admission to a trauma center inCapeTown. The most common cause of injuries were motor vehicle accidents (33) followed by falls (31); sports (8);poisoning (3); and bicycle accidents (2). Fourteen (14) children were injured non-accidentally. The majority of injured children were from poor socio-economic circumstances with a mean family income of 894R (130 USD) per month. Alcohol played a role in the etiology of at least 21of the injuries.Children are vulnerable to injuries in our society and there is presently too little direction on preventative aspects of these injuries