RESUMO
Seating position in motor vehicle collisions [MVC] plays a major role in determining the injury pattern in mainly restrained children. However, compliance with child seating and restraint laws is still suboptimal. The role of seating position in predicting injury patterns among unrestrained children has not been previously studied. Retrospective review based on the trauma registry of a level I trauma center in Riyadh, Saudi Arabia. Data collection was restricted to unrestrained children involved in MVC. Between July 2001 and March 2010, 274 records were identified. Detailed information about the collision, child seating position and the use of restraints was cross-verified using parental phone interviews. Of the 274 identified records, cross-verification was possible for 89 [32.4%] unrestrained children, 64 boys and 25 girls, with a mean [SD] age of 83 [40] months. Of these children, 41 [46.1%] were front seated [FS], and 48 [53.9%] were back seated [BS]. There were higher rates of rollover [52.1% vs 24.4%, P=.02], ejection [41.7% vs 22%, p=.05], and occupant death ratio [14.8 vs 4, P=.04] among BS children. However, the two groups did not differ in pediatric trauma scores, Glascow coma scale score, or age distribution. FS children were more likely to suffer long bone or pelvic fractures [LPF] [60.4% vs 36.6%, P=.025]. Injury pattern can vary according to seating position among unrestrained children presenting at trauma centers after MVC. While FS children are more likely to present with HNFI, BS children more often sustain LPF. BS children had similar trauma severity compared with FS children despite the higher-impact nature of their MVCs. While highlighting the value of proper restraints use and seating position, these results can be valuable in the initial assessment of traumatized children involved in MVC
RESUMO
Hypertrophic pyloric stenosis [HPS] is a common cause of gastric outlet obstruction [GOO] in infants. Prolonged GOO is believed to result in acid and electrolyte disturbances, gastric atony, and delayed postoperative recovery. We studied the impact of prolonged vomiting as an indicator of GOO symptoms on the post-operative outcomes in HPS. A retrospective chart review of all patients who underwent pyloromyotomy at a tertiary care center between February 1997 and February 2009. The duration of pre-operative vomiting was correlated with presenting electrolytes and acid-base balances, postoperative time to full feed, postoperative morbidity and duration of hospitalization. Forty-seven patients were identified. At presentation, the median [range] for duration of symptoms was 14 [3-60] days, and surgeries were performed at 2 [0-6] days after admission. Apart from one case of postoperative wound infection, all patients had an unremarkable recovery. The unusually prolonged duration of vomiting in our cohort did not correlate with the mean [SD] preoperative chloride level of 93.9 [8.8] mEq/L, mean [SD] pH level of 7.5 [0.9], mean postoperative time to full feeding of 31 [15.1] hours, or mean duration of hospitalization of 5.1 [2.2] days. Duration of vomiting in HPS at presentation does not seem to have a significant impact on the postoperative outcomes