Meningitis in Children: Still a Can't-Miss Diagnosis.

Although vaccination and antimicrobial treatment have significantly impacted the frequency and outcomes of meningitis in children, meningitis remains a critical can't-miss diagnosis for children, where early recognition and appropriate treatment can improve survival and neurologic outcomes. Signs and symptoms may be nonspecific, particularly in infants, and require a high index of suspicion to recognize potential meningitis and obtain the cerebrospinal fluid studies necessary for diagnosis. Understanding the pathogens associated with each age group and specific risk factors informs optimal empirical antimicrobial therapy. Early treatment and developmental support can significantly improve the survival rates and lifelong neurodevelopment of children with central nervous system infections.

Association Between In-Training Exam Scores and Clinical Exposure During the COVID-19 Pandemic.

BACKGROUND: We sought to evaluate changes in In-Training Examination (ITE) scores and associations with clinical work during the COVID-19 pandemic. We hypothesized that residents saw a decrease in clinical encounters during the pandemic and that this would be associated with smaller gains in ITE scores. METHODS: We compared ITE score changes with data on patient notes for three classes of pediatric residents at four residency programs: one not exposed to the pandemic during their intern year who entered residency in 2018, one partially exposed to COVID-19 in March of their intern year (2019-2020), and one that was fully exposed to the pandemic, starting residency in June of 2020. RESULTS: ITE scores on average improved from the PGY1 to PGY2 year in the "no covid" and "partial COVID" cohorts. The "full COVID" cohort had little to no improvement, on average. The total number of patient encounters was not associated with a change in ITE scores from PGY1 to PGY2. There was a small but statistically significant association between change in ITE score and number of inpatient H+P notes. CONCLUSIONS: A drop in ITE scores occurred in pediatric residents who entered residency during the COVID-19 pandemic. This change was largely unrelated to clinical encounter number changes.

Demographic and clinical characteristics of pediatric COVID-19 in Arkansas: March-December 2020.

The COVID-19 pandemic reached the United States in early 2020 and spread rapidly across the country. This retrospective study describes the demographic and clinical characteristics of 308 children presenting to an Arkansas Children's emergency department (ED) or admitted to an Arkansas Children's hospital with COVID-19 in the first 10 months of the COVID-19 pandemic, prior to the emergence of clinically significant variants and available vaccinations. Adolescents aged 13 and older represented the largest proportion of this population. The most common presenting symptoms were fever, gastrointestinal symptoms, and upper respiratory symptoms. Patients with multisystem inflammatory syndrome in children (MIS-C) had a longer length of stay (LOS) than patients with acute COVID-19. Children from urban zip codes had lower odds of admission but were more likely to be readmitted after discharge. Nearly twenty percent of the study population incidentally tested positive for COVID-19. Despite lower mortality in children with COVID than in adults, morbidity and resource utilization are significant. With many Arkansas children living in rural areas and therefore far from pediatric hospitals, community hospitals should be prepared to evaluate children presenting with COVID-19 and to determine which children warrant transport to pediatric-specific facilities.

Foot injuries associated with all-terrain vehicle use in children and adolescents.

OBJECTIVES: Children can suffer serious foot injuries while riding or driving an all-terrain vehicle (ATV). The purpose of this study was to describe this injury pattern. METHODS: A search of the trauma registry of the Arkansas Children's Hospital for the years 1998 through 2006 was conducted to find cases of children admitted for treatment of foot injuries related to ATV use. The cases were deidentified and summarized. The study was reviewed and deemed to be exempt by the local institutional review board. RESULTS: Ten cases of foot injury were identified. The median age was 3 years. Eight had forefoot injuries, including 6 who had amputation of the great toe. All but one patient had multiple open foot fractures. Seven required skin grafting. Complications included infection, scar formation, disfigurement, and gait disturbance. The mean length of stay on initial hospitalization was 6 days, and the mean hospital charge was $12,890. CONCLUSIONS: Children, particularly young children, on an ATV can suffer serious foot injuries resulting in disfigurement and disability. The recommendation that young children not ride on ATVs is emphasized by these findings.

The increasing threat of personal watercraft injuries.

A trend of increasing number and severity of injuries associated with use of personal watercraft (PWC) has been noted as the use and popularity of PWC also rises. The rate of injuries secondary to PWC use is greater than that from other water sports. Multiple etiologies of injury have been reported, including closed head trauma, spinal injuries, facial fractures, chest trauma, abdominal injuries, and drowning. These injuries may occur from collision with other objects, falls from the PWC, and encounters with the hydrostatic jet stream. The most significant contributing factors to injury seem to be carelessness and inattention. However, some studies show that substance abuse may also contribute. Recommendations to reduce morbidity and mortality include using U.S. Coast Guard-approved personal flotation devices (PFD), limiting use of PWC to trained adults, and improving recognition of significant PWC injury by medical personnel.