Role of flexion-extension radiographs in blunt pediatric cervical spine injury.

OBJECTIVE: To determine whether flexion-extension cervical spine radiography (FECSR) is abnormal in children who have sustained blunt cervical spine injury (CSI) when standard cervical spine radiography (SCSR) demonstrates no acute abnormalities. METHODS: This was a blinded radiographic review of 129 patients < or = 16 years of age evaluated at an academic pediatric trauma center during July 1990-March 1996. All patients had SCSR (anteroposterior/lateral views) and FECSR performed for a trauma-related event within seven days of injury. RESULTS: Of 46 patients without acute abnormalities on SCSR, one patient (with final clinical diagnosis of "no CSI") had acute abnormalities on FECSR (95% CI = 0.06% to 11.5%). Of 50 patients with isolated loss of lordosis on SCSR, no patient had acute abnormalities on FECSR (95% CI = 0% to 5.8%). The FECSR review revealed no acute abnormalities in 75 of 83 patients (90.4%) with suspicious findings for CSI viewed on SCSR (95% CI = 81.9% to 95.7%). Complications during FECSR were noted in one patient with transient paresthesias (0.8%) (95% CI = 0.02% to 4.2%). CONCLUSIONS: In children who underwent acute radiographic evaluation of blunt cervical spine trauma, FECSR was unlikely to be abnormal when no acute abnormality or isolated loss of lordosis was evident on SCSR. In a subset of patients with suspicious findings for occult CSI on SCSR, FECSR was useful in ruling out ligamentous instability in the acute, posttrauma setting.

The abuse clarification process in the treatment of intrafamilial child abuse.

OBJECTIVE: One aspect of treatment for child abuse and neglect addresses the attributions that the child victim, offender, nonoffending parents, and other family members have about the occurrence of the maltreatment. This paper describes a formal approach for abuse clarification to be used with families in which maltreatment has occurred. The four primary components of the abuse clarification process are: (a) clarification of the abusive behaviors; (b) offender assumption of responsibility for the abuse; (c) offender expression of awareness of the impact of the abuse on the child victim and family; and, (d) initiation of a plan to ensure future safety. The process of abuse clarification is described and suggestions made for appropriate use of the procedure.

Transient myocardial dysfunction in a child with salicylate toxicity.

Aspirin overdose may result in acid-base disturbances, electrolyte abnormalities, pulmonary edema, chemical hepatitis, seizures, and mental status alteration, but myocardial depression has not been reported following aspirin overdose in children. In addition to these more typical features, the 13-month-old boy reported here developed clinical, radiographic, and echocardiographic evidence of myocardial impairment with pulmonary edema and moderately severe global left ventricular dysfunction (estimated shortening fraction of 23%). Complete resolution of the myocardial dysfunction was demonstrated on follow-up echocardiography as the child recovered from the aspirin intoxication. This case suggests that myocardial dysfunction can occur as a result of toxic aspirin ingestion, and that it may contribute to salicylate-induced pulmonary edema.

Glaucoma screening in primary care: the role of noncontact tonometry.

BACKGROUND: Guidelines for glaucoma screening by the primary care physician have not been firmly established. Despite its limitations as a screening test, intraocular pressure measurement by tonometry remains the mainstay of glaucoma monitoring but is not widely used in the primary care setting. The purpose of this study was to compare the effectiveness of noncontact tonometry using the Pulsair instrument with that of conventional tonometry using the Goldmann applanation tonometer as a screening tool for glaucoma. METHODS: Intraocular pressure was measured by non-contact and Goldmann applanation tonometry in both eyes of 50 volunteers who enrolled in a glaucoma screening program at a primary care clinic. RESULTS: Noncontact tonometry correctly identified over 90% of the patients with intraocular pressures greater than 22 mm Hg. CONCLUSIONS: Noncontact tonometry is an easy, practical, and well-tolerated method of intraocular pressure measurement. When combined with direct ophthalmoscopy, noncontact tonometry can easily be used in routine primary care health examinations to detect glaucoma.

Medical interview of sexually abused children.

Physicians seeing sexually abused children in their practices often fail to recognize the abuse. Recognizing the frequency of child sexual abuse and variety of presentations will alert physicians to seek explanation. Physicians should know the common behavior of perpetrators and how to encourage children to reveal and describe the abuse. Information gained through effective interviewing can be used to plan appropriate medical investigations, to form the basis of a protective service report, and as a sound introduction to counseling for sexual assault. Improved medical support to protective service agencies will improve their capacity to protect victims of sexual abuse, and competent educational support by physicians will improve their immediate and long-term emotional adjustment.