Strategic Surge Responses in the COVID-19 era: Operational Themes, Innovative Solutions and Lessons Learned by Three Freestanding Pediatric Emergency Departments.

The prolonged COVID-19 pandemic has created unique and complex challenges in operational and capacity planning for pediatric emergency departments, as initial low pediatric patient volumes gave way to unpredictable patient surges during Delta and Omicron variants. Compounded by widespread hospital supply chain issues, staffing shortages due to infection and attrition, and a concurrent pediatric mental health crisis, the surges have pushed pediatric emergency department leaders to re-examine traditionally defined clinical processes, and adopt innovative operational strategies. This study describes the strategic surge response and lessons learned by 3 major freestanding academic pediatric emergency departments in the western United States to help inform current and future pediatric pandemic preparedness.

Hand and Wrist Injuries Among US High School Athletes: 2005/06-2015/16.

BACKGROUND: The risk of hand/wrist injuries is present across various sports. Little is known about the epidemiology of such injuries. The objective of this study was to calculate the rates of hand/wrist injuries and investigate injury patterns among high school athletes. METHODS: Athlete exposure (AE) and hand/wrist injury data were collected during 11 academic years, 2005/06 through 2015/16, from a large sample of US high schools as part of the National High School Sports-Related Injury Surveillance Study. RESULTS: There were 6723 hand/wrist injuries sustained during 40 195 806 AEs, a rate of 1.7 per 10 000 AEs. The rate of injury in competition (3.3) was higher than in practice (1.1) (95% confidence interval: 2.8-3.1). Rates of hand/wrist injuries varied by sport, with the highest rates in football (4.3), boys' lacrosse (1.9), girls' softball (1.9), wrestling (1.8), girls' field hockey (1.7), boys' ice hockey (1.7), and girls' basketball (1.7). The most common injuries were fracture (45.0%), contusion (11.6%), and ligament sprain (9.0%). Athletes most frequently returned to play in <7 days (45.7%), but 12.4% of injuries kept athletes out ≥3 weeks. CONCLUSIONS: High school athletes are at risk for hand/wrist injuries. Such injuries can keep athletes out of play and many require substantial medical treatment. Stick and ball or puck sports and full contact sports have high rates of hand/wrist injuries relative to other sports, which is indicative of a need for sport-specific prevention efforts.

Epidemiology of Chest, Rib, Thoracic Spine, and Abdomen Injuries Among United States High School Athletes, 2005/06 to 2013/14.

OBJECTIVE: Describe chest and abdominal injury epidemiology among US high school athletes. DESIGN: Retrospective analysis of longitudinal surveillance data. SETTING: Injury data from 2005/06 to 2013/14 academic years were collected using an internet-based surveillance system. PARTICIPANTS: A large sample of US high schools. ASSESSMENT OF RISK FACTORS: Injuries sustained as a function of sport. MAIN OUTCOME MEASURES: Chest, rib, thoracic spine, and abdominal injuries sustained during high school athletic events. RESULTS: Overall 1487 chest, rib, thoracic spine, and abdominal injuries occurred during 30 415 179 athletic exposures (AEs); an injury rate of 4.9 injuries per 100 000 AEs. Over half (56.8%) of injured athletes were evaluated by another medical provider in addition to the athletic trainer, and 34 injuries (2.3%) required surgery. Diagnostic techniques, including x-ray, magnetic resonance imaging or computed tomography were used in 729 (49.0%) injuries. The injury rate was higher in boys' (6.8) than girls' (2.0) sports [rate ratio (RR), 3.43; 95% CI, 3.04-4.10]. Football (47.7%) accounted for the highest proportion of injuries followed by wrestling (18.5%), boys' soccer (4.6%), and girls' soccer (3.7%). The rate of injury was higher in competition than practice, (RR, 2.86; 95% CI, 2.59-3.23). Only 57.7% of injured athletes were able to return to play within 1 week. CONCLUSIONS: Chest and abdominal injuries in high school sports although relatively rare, can result in loss of playing time and frequently prompt medical evaluation. Thus, they present a physical and economic burden. To optimize prevention, further studies can focus on subgroup risk factor identification to drive development of targeted prevention strategies.

Pediatric blast lung injury from a fireworks-related explosion.

Blast injuries related to explosions have been described in the literature but are uncommon in children. We describe a multisystem blast injury in a child resulting from a commercial firework-related explosion in her home. She presented with respiratory failure, shock, altered level of consciousness, and multiple orthopedic injuries. The patient required immediate stabilization and resuscitation in the emergency department and a prolonged hospitalization. This report reviews the spectrum of injuries that are seen in blast-related trauma and the emergency measures needed for rapid stabilization of these critical patients.

Renal stones: evolving epidemiology and management.

The incidence of renal stones in adults has increased significantly over time. Although published evidence is somewhat limited, during the last 10 years, there have been reports of 4-fold increase in the number of children evaluated for nephrolithiasis, and of those, a 7-fold increase in diagnosis of stone disease. The etiology of stone formation has shifted over time, with a transition from infectious causes to metabolic causes. It was our goal in this review of the literature on pediatric renal stone disease to further highlight the changing epidemiology and etiology as well as provide a framework for appropriate clinical evaluation and use of diagnostic tools when approaching a patient with suspected renal stone disease. We also provide guidance regarding treatment and prevention of renal stone disease in children.