A Case of Pediatric Sternal Fracture Diagnosed by POCUS.

A previously healthy, 4-year-old boy visited our emergency department due to chest pain after a fall from a skate scooter. Physical examination revealed tenderness over the sternal body. Point of care ultrasound (POCUS) of the sternum demonstrated a discontinuation of a hyperechoic structure of the sternal cortex, suggesting a sternal fracture. POCUS did not detect intraperitoneal fluid, pericardiac effusion, or pneumothorax. Plain radiograph confirmed the diagnosis of isolated sternal fracture and the patient was discharged with conservative treatment. POCUS was useful not only in diagnosing a sternal fracture but also to rule out concurrent injuries.

Deep Neural Network-Based Respiratory Pathology Classification Using Cough Sounds.

Intelligent systems are transforming the world, as well as our healthcare system. We propose a deep learning-based cough sound classification model that can distinguish between children with healthy versus pathological coughs such as asthma, upper respiratory tract infection (URTI), and lower respiratory tract infection (LRTI). To train a deep neural network model, we collected a new dataset of cough sounds, labelled with a clinician's diagnosis. The chosen model is a bidirectional long-short-term memory network (BiLSTM) based on Mel-Frequency Cepstral Coefficients (MFCCs) features. The resulting trained model when trained for classifying two classes of coughs-healthy or pathology (in general or belonging to a specific respiratory pathology)-reaches accuracy exceeding 84% when classifying the cough to the label provided by the physicians' diagnosis. To classify the subject's respiratory pathology condition, results of multiple cough epochs per subject were combined. The resulting prediction accuracy exceeds 91% for all three respiratory pathologies. However, when the model is trained to classify and discriminate among four classes of coughs, overall accuracy dropped: one class of pathological coughs is often misclassified as the other. However, if one considers the healthy cough classified as healthy and pathological cough classified to have some kind of pathology, then the overall accuracy of the four-class model is above 84%. A longitudinal study of MFCC feature space when comparing pathological and recovered coughs collected from the same subjects revealed the fact that pathological coughs, irrespective of the underlying conditions, occupy the same feature space making it harder to differentiate only using MFCC features.

Identifying Children With Measles for Isolation in a High-volume Pediatric Emergency Department in Singapore.

BACKGROUND: Viral exanthems in the pediatric age group are common. The worldwide increase in the incidence of highly infectious measles and other vaccine-preventable diseases and its impact in emergency departments (EDs) of a cosmopolitan city-state like Singapore are unknown. Our aims were to investigate and describe recent epidemiologic trends of proven measles infection seen in our ED and elucidate risk factors that can potentially impact our ED isolation practice. METHODS: This is a retrospective observational cohort study on laboratory-confirmed measles infection in patients admitted through our pediatric ED from January 2010 to December 2016. RESULTS: A total of 277 patients were hospitalized for measles infection during the study period. Of these, 177 patients (63.9%) were not isolated initially at the ED triage and 92 patients (33.2%) were not admitted to isolation wards on admission. Seventy-five patients (27.1%) with microbiologically proven measles had no rash at initial ED presentation. They presented earlier in their illness (3.1 days) compared with an average of 4.8 days for those who had a rash at presentation (P < 0.001). These patients without rash were younger, and most were admitted for poor feeding. CONCLUSIONS: Our study found that most pediatric patients who required hospitalization presented with nonspecific symptoms at an early phase of illness, making it challenging to adequately isolate patients despite strict isolation policies. This calls for the importance of universal push for global vaccination to increase herd immunity to prevent measles infection.