Rehabilitation Care of the Child with an Acute Severe Traumatic Brain Injury.

Children with traumatic brain injury (TBI) represent a unique and evolving population. Recovery and long-term prognosis are variable given the heterogeneity of ages, developmental stages, and types of injuries. This article summarizes important information regarding severe TBI epidemiology, pathophysiology, classification, and acute management. Early and longitudinal involvement of rehabilitation experts, such as pediatric physiatrists, is critical in managing complications and optimizing outcomes.

Human papillomavirus vaccination rates in adolescents with cerebral palsy compared to the general population.

PURPOSE: To determine whether adolescents with cerebral palsy (CP) initiate and are up-to-date with the human papillomavirus (HPV) immunization series compared to adolescents in the general population. METHODS: Data on initiation and up-to-date status of the HPV series were collected on adolescents with CP aged 13-17 years old (n = 74) via retrospective medical record review and compared to 616 age-matched peers from the National Immunization Survey, Teen 2019. Analysis by gender, Gross Motor Functional Classification System (GMFCS) level, and ambulatory status was performed in the CP group. RESULTS: Adolescents with CP were three times less likely to start (p < 0.001) and two times less likely to be up-to-date (p = 0.004) with the HPV immunization series compared to age-matched peers. When the HPV immunization series was initiated in adolescents with CP, these adolescents were as likely to complete the series (p = 0.400), with 83.3% being up-to-date. In those with CP, there was no statistical difference in status of the HPV immunization series when comparing gender, GMFCS level, or ambulatory status. CONCLUSION: Adolescents with CP were less likely to start the HPV immunization series; however, they were as likely to be up-to-date with the series if it was initiated. This presents an opportunity for pediatric physiatrists to help reduce the disparity.

Seizures: A Rare Presentation of Autonomic Dysreflexia in a Young Adult with Complete Spinal Cord Injury.

BACKGROUND: Autonomic dysreflexia (AD) is a common complication for individuals with cervical or upper-mid thoracic spinal cord injury (SCI). It is a life-threatening emergency; however, it is rarely encountered by many emergency physicians, thus, ongoing awareness of the topic is necessary. CASE REPORT: An 18-year-old man with cervical spinal cord injury presented to the Emergency Department with headache, nausea, elevated blood pressure, and seizures. He was treated with antiepileptics and transferred to the pediatric intensive care unit (PICU). The PICU care team recognized AD as the cause of the seizure, secondary to a clogged suprapubic catheter causing overdistension of his bladder. Once replaced, over 1 liter of urine drained from his bladder and his autonomic symptoms resolved. He became hypotensive and required fluid resuscitation, but no further seizures occurred. Why Should an Emergency Physician Be Aware of This? Although rare, AD can result in seizures, intracerebral hemorrhage, or even death if not recognized or treated appropriately. Emergency physicians should recognize headaches, facial flushing, and sweating as early symptoms of AD, along with acute elevation in blood pressure (noting that baseline blood pressure may be lower in individuals with SCI). Management involves evaluating and treating noxious stimuli below the level of neurologic injury. Symptom management alone, without resolution of the underlying issue, can add to morbidity and mortality.