Cardiorespiratory fitness predicts clustered cardiometabolic risk in 10-11.9-year-olds.

The aim of this study was to investigate levels of clustered cardiometabolic risk and the odds of being 'at risk' according to cardiorespiratory fitness status in children. Data from 88 10-11.9-year-old children (mean age 11.05 ± 0.51 years), who participated in either the REACH Year 6 or the Benefits of Fitness Circuits for Primary School Populations studies were combined. Waist circumference, systolic blood pressure, diastolic blood pressure, glucose, triglycerides, high-density lipoprotein cholesterol, adiponectin and C-reactive protein were assessed and used to estimate clustered cardiometabolic risk. Participants were classified as 'fit' or 'unfit' using recently published definitions (46.6 and 41.9 mL/kg/min for boys and girls, respectively), and continuous clustered risk scores between fitness groups were assessed. Participants were subsequently assigned to a 'normal' or 'high' clustered cardiometabolic risk group based on risk scores, and logistic regression analysis assessed the odds of belonging to the increased cardiometabolic risk group according to fitness. The unfit group exhibited significantly higher clustered cardiometabolic risk scores (p < 0.001) than the fit group. A clear association between fitness group and being at increased cardiometabolic risk (B = 2.509, p = 0.001) was also identified, and participants classed as being unfit were found to have odds of being classified as 'at risk' of 12.30 (95 % CI = 2.64-57.33). Conclusion Assessing cardiorespiratory fitness is a valid method of identifying children most at risk of cardiometabolic pathologies. The ROC thresholds could be used to identify populations of children most at risk and may therefore be used to effectively target a cardiometabolic risk-reducing public health intervention.

Peri-cardiac arrest following blunt bicycle handlebar trauma to the iliac vessels: management of a rare case.

Iliac vessel disruption following blunt trauma is an unusual presentation, particularly in the absence of an orthopaedic injury. We present the unique case of a 14-year-old boy who sustained a blunt bicycle handlebar impalement that resulted in complete transection of the external iliac artery and laceration of the external iliac vein, without a skeletal fracture. The patient deteriorated rapidly, entering hypovolaemic shock and peri-cardiac arrest at anaesthetic induction. Once haemodynamic stability was achieved, the lacerated external iliac vein was used to form an interposition graft to repair the external iliac artery. The rare occurrence and lack of familiarity with this injury, combined with the potential for fatal exsanguination if not swiftly diagnosed makes this case crucial to highlight. Blunt bicycle handlebar injury should carry a high suspicion of severe vascular compromise. If diagnosed this should be rapidly managed with aggressive resuscitation and revascularisation.