Clinical evaluation and outcomes in children ≤10 years old involved in road traffic accidents, presenting to Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa

Background. Road traffic accidents (RTAs) are a leading cause of injury and death globally, particularly among children. Pedestrians are most often injured, especially in middle- and low-income countries. The epidemiology, patterns and severity of injuries in children involved in RTAs in our community are hard to obtain. Objectives. To evaluate the aetiological spectrum, injury characteristics and treatment outcomes of paediatric patients involved in RTAs,who presented to Chris Hani Baragwanath Academic Hospital (CHBAH), a tertiary hospital in Soweto, South Africa. Methods. Patients ≤10 years old, who were involved in RTAs and seen at CHBAH, were included in the study. Results. The study was conducted from 20 August 2017 to 31 March 2018, and included the data of 156 patients. Their ages ranged from 13 days to 10 years (65% were boys). Pedestrian vehicle accidents accounted for 78.8% of the injuries, with 60.8% of the children being unaccompanied by an adult. Motor vehicle accidents accounted for 19.2% of the injuries, with 92% of the children being unrestrained in the vehicle. Of the patients, 73.2% (n=112/153) underwent radiography and 44.4% required computed tomography (CT) scans, the majority being CT scans of the brain for suspected head injuries. Soft-tissue injuries accounted for 78.9% of cases, followed mainly by head (39.7%) and limb (16%) injuries. Only 12% of patients required surgical intervention, with 42% of the operations being for orthopaedic injuries. Conclusion. The abovementioned data demonstrate that there is a lack of use of child restraints for children travelling as passengers invehicles, and inadequate supervision of children on and around roads. This study supports other evidence, as it suggests that the paediatric population involved in RTAs is largely injured as pedestrians, and that males tend to be involved in more RTAs than females. The majority of injuries sustained involved the soft tissues, followed by head injuries

Demographics of paediatric patients presenting with acute appendicitis: A 5-year retrospective review of hospitals served by the Department of Paediatric Surgery at the University of the Witwatersrand

Background. There are no recently published data on the incidence and demographics or perforation rates of paediatric patients from our local population presenting with acute appendicitis. Objective. To show the age and gender distribution of paediatric patients presenting with acute appendicitis within our communities, as well as demonstrating the incidence of perforated acute appendicitis in our paediatric population. Method. The study is a retrospective record review of all paediatric patients who presented with acute appendicitis to the Department of Paediatric Surgery at both Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), and Chris Hani Baragwanath Academic Hospital (CHBAH) from June 2010 to September 2015. Data collected included all demographic data as well as histology results of patients who underwent appendectomies. Results. The total numbers of patients included in the study were 544; 234 at CHBAH, and 311 at CMJAH. The male-to-female ratio was 1.58:1. The mean age for presentation at both hospitals combined was 8.76 years. We found that 13.41% of paediatric patients with acute appendicitis in this cohort were under the age of 6 years. A histological review showed that 50.1% of patients in our cohort presented with complicated appendicitis, and we had a negative appendectomy rate of 8.4%. Histological results of patients under the age of 6 years revealed a higher negative appendicectomy rate of 11.4%. However, the incidence of complicated appendicitis in this age group was only 45.7%, which is lower than that reported in the literature. Three patients were found to have Enterobius vermicularis in the lumen of the appendix, and Ascaris ova were identified in one patient. Histology revealed a low-grade mucinous neoplasm in one patient. Conclusion. Acute appendicitis occurred at a median age of 8.76 years in our study population, with a male-to-female ratio of 1.58:1. We found that acute appendicitis occurred relatively more frequently in our patients under the age of 6 years compared with the incidence of acute appendicitis in this age group published elsewhere. Complicated appendicitis occurred in 50.1% of our patient population, with an increased frequency of perforated appendicitis occurring in our male population. However, complicated appendicitis occurred in only 44.7% of our patients below the age of 6 years, which is in stark contrast to published literature. Helminthic infections were rare associated pathogens in our study, and an unlikely underlying pathogen of acute appendicitis in our population