What do children aged 12-18 think about COVID-19 vaccines?

OBJECTIVES

Vaccines are crucial for preventing the spread of the coronavirus pandemic and controlling its effects. We aimed to determine the desire of children aged 12-18 to be vaccinated with the current vaccines, the reasons for wanting or not wanting to be vaccinated, where they had learned about the vaccine, how many of the children with a history of chronic disease want to be vaccinated, and which factors affect them.

METHODS

A questionnaire form was completed for children aged 12-18 years who applied to Gazi University Pediatric Emergency Department and the Child Health and Diseases Polyclinic between April 1, 2022, and September 30, 2022.

RESULTS

A total of 924 children participated in the study. The mean age of the participants was 14.64±1.77 years. The willingness to be vaccinated was 83.1%. Being older, living in the city, having a mother, father, or sibling who was vaccinated, information about vaccines obtained from health personnel, a completed national vaccination program, and the presence of a first-degree relative in the healthcare field significantly increased the probability of the child being vaccinated. The most important factors affecting the desire to be vaccinated in children were the vaccination status of the mother, father, or sibling and the completed national vaccination program.

CONCLUSION

We found that the immunization status of the parents is the most important factor guiding the child's desire to be vaccinated and that the most common reason for vaccine hesitancy is the side effects of the vaccine.

Traumatic brain injury detection performance of the infant scalp score in children younger than 2 years in the pediatric emergency department

BACKGROUND

Our study sought to externally validate the Infant Scalp Score (ISS) within an international pediatric emergency department (PED) setting. The ISS for pediatric Closed Head Injury (CHI), includes age, hematoma localization, and size, and has the potential to predict the presence of Traumatic Brain Injury (TBI) on computed tomography. We aimed to describe a potentially low risk cohort of children younger than 24 months with CHI and scalp hematomas, where clinicians may limit diagnostic radiation exposure to this vulnerable patient population.

METHODS

This single-center retrospective study was conducted in Gazi University. Faculty of Medicine, Pediatric Emergency Department, a tertiary trauma care hospital. We reviewed patients (< 24 months) with CHI and scalp hematoma who visited the PED of our institution between January 1, 2019, and June 30, 2021 for rates of TBI and clinically important TBI (ciTBI).

RESULTS

380 cases met inclusion criteria for this study. The median age was 11 months and 58.7% were male children. 121 (31.8%) patients underwent CT, and 57% (n:69) of these studies were normal. TBI on CT was found in 26 (21.5%) patients with ciTBI was detected in 5 (1.3%) patients. All children with TBI were noted to have ISS scores of ≥ 5. Hematoma location OR 18.9 (95% CI, 3.4-105.1) and hematoma size OR 3.0 (95% CI, 1.2-7.3) were positively associated with presence of TBI.

CONCLUSIONS

Children with ISS scores of ≥ 5 were noted to have increased rates of both TBI and ciTBI. CHI related scalp hematomas located in the temporal/parietal region or with a size greater than 3 cm were associated with increased rates of TBI. Within the context of this study, ISS scores of 4 or less represented a lower risk for TBI and ciTBI. Future research on this potentially low risk pediatric CHI cohort is needed.

COVID-19 disease in children presenting to the pediatric emergency department: A multicenter study with 8886 cases from Turkey

Background

The aim was to evaluate the epidemiological, clinical, laboratory, and radiologic data of children with SARS-CoV-2 positivity by polymerase chain reaction (PCR) together with treatment strategies and clinical outcomes and to evaluate cases of multisystem inflammatory syndrome in children (MIS-C) in this population.

Methods

This was a multicenter retrospective observational cohort study performed in the pediatric emergency departments of 19 tertiary hospitals. From March 11, 2020, to May 31, 2021, children who were diagnosed with confirmed nasopharyngeal/tracheal specimen SARS-CoV-2 PCR positivity or positivity for serum-specific antibodies against SARS-CoV-2 were included. Demographics, presence of chronic illness, symptoms, history of contact with SARS-CoV-2 PCR-positive individuals, laboratory and radiologic investigations, clinical severity, hospital admissions, and prognosis were recorded.

Results

A total of 8886 cases were included. While 8799 (99.0%) cases resulted in a diagnosis of SARS-CoV-2 with PCR positivity, 87 (1.0%) patients were diagnosed with MIS-C. Among SARS-CoV-2 PCR-positive patients, 51.0% were male and 8.5% had chronic illnesses. The median age was 11.6 years (IQR: 5.0–15.4) and 737 (8.4%) patients were aged <1 year. Of the patients, 15.5% were asymptomatic. The most common symptoms were fever (48.5%) and cough (30.7%) for all age groups. There was a decrease in the rate of fever as age increased (p < 0.001); the most common age group for this symptom was <1 year with the rate of 69.6%. There was known contact with a SARS-CoV-2 PCR-positive individual in 67.3% of the cases, with household contacts in 71.3% of those cases. In terms of clinical severity, 83 (0.9%) patients were in the severe-critical group. There was hospital admission in 1269 (14.4%) cases, with 106 (1.2%) of those patients being admitted to the pediatric intensive care unit (PICU). Among patients with MIS-C, 60.9% were male and the median age was 6.4 years (IQR: 3.9–10.4). Twelve (13.7%) patients presented with shock. There was hospital admission in 89.7% of these cases, with 29.9% of the patients with MIS-C being admitted to the PICU.

Conclusion

Most SARS-CoV-2 PCR-positive patients presented with a mild clinical course. Although rare, MIS-C emerges as a serious consequence with frequent PICU admission. Further understanding of the characteristics of COVID-19 disease could provide insights and guide the development of therapeutic strategies for target groups.

Benign acute childhood myositis: Factors associated with muscle symptoms and resolution

BACKGROUND

Benign acute childhood myositis (BACM) is associated with several viral infections. The aim of this study was to evaluate the progression of myositis symptoms, laboratory findings and oseltamivir treatment in children with influenza- and non-influenza-associated BACM.

METHODS

Patients aged 0-18 years old, admitted to the pediatric emergency department in the seasonal influenza period between 2018 and 2020 were retrospectively analyzed. Patients with acute onset calf tenderness, pain, difficulty in walking and elevated serum creatine phosphokinase were included and were grouped according to influenza rapid test kit results as influenza (A and B) positive, and influenza negative. The time to symptom resolution, laboratory data and the oseltamivir treatment were compared between the groups.

RESULTS

There were 94 patients (67 male, 27 female) with a mean age of 77 ± 22 months. Influenza A was detected in 21, influenza B in 27, and neither were detected in 46 patients. Time to symptom resolution of BACM was shorter in the influenza-positive patients than in influenza-negative patients (2.9 ± 1.4 days and 3.5 ± 1.5 days, respectively, P = 0.027). Oseltamivir did not reduce the symptom resolution time in influenza patients. All children had normal hemoglobin and platelet counts, elevated creatine phosphokinase and 76% of them had leukopenia. Neither clinical recurrence nor metabolic disease were reported.

CONCLUSION

Symptoms of BACM tended to resolve slightly earlier in influenza-positive patients and the duration of symptoms was not affected by oseltamivir treatment.

Contribution of Rapid Influenza Antigen Test to Management of Febrile Young Infants without a Focus

BACKGROUND

The aim of this study was to evaluate the application of the rapid influenza antigen test and the contribution of the test result to patient management in febrile infants aged 29‒90 days.

METHODS

The medical records of febrile infants without a focus who presented during influenza seasons from 2017‒2019 were analyzed retrospectively. The study was carried out in the Department of Pediatric Emergency, Dr. Sami Ulus Maternity and Children's Training and Research Hospital. The demographic characteristics, clinical and laboratory findings, and management of the patients were examined. The patients were divided into two groups as 'with' and 'without' testing based on whether a rapid influenza antigen test was performed or not. Test results were categorized as positive or negative. Serious bacterial infection (SBI) risk and patient management were evaluated according to test results.

RESULTS

A total of 173 patients (110 males/63 females) were evaluated. The influenza test was performed in 94 (54.3%) patients, and 31.9% were positive. SBI was present in 8.7% of all patients. The mean values of white blood cell (WBC), absolute neutrophil, platelet count, C-reactive protein (CRP) and, lumbar puncture, hospitalization, and initiation of antibiotic therapy were significantly lower in the positive group compared to the negative and without testing groups (P<0.05).

CONCLUSION

This study showed that using the influenza test in the emergency department in young febrile infants significantly reduced the use of antibiotics, hospitalization and the implementation of invasive procedures such as lumbar puncture, and the risk of SBI was not increased.

Evaluation of changes in pediatric emergency department utilization during COVID-19 pandemic: Changes during COVID-19 pandemic

Background

During the coronavirus disease 2019 (COVID-19) pandemic period, the use of emergency services with pediatric non-COVID patients has decreased considerably. We aimed to examine whether there was a change in the demographic data, triage profile, causes, management, and cost of pediatric emergency department (PED) visits of non-COVID patients during the pandemic period.

Methods

This study was a retrospective, single-center, observational comparative study that was conducted at the PED. Patient records were examined during “the pandemic spring” and the same period of the previous year. Patient demographics, waiting time, and outcome of the PED visit were analyzed in the entire population of children admitted to the PED during the study period, whereas more precise data such as the reason for PED use, duration of symptoms, urgency levels according to the Emergency Severity Index (ESI), final diagnosis, management, and cost of patient care were analyzed in a sample of admitted patients. We used the chi-square test, Fisher's exact test, and Mann–Whitney U test for statistical analyses.

Results

A total of 62,593 PED visits occurred. During the pandemic period, PED visits showed a decrease of 55.8% compared to the previous year. Patients included in the sampling study group were selected using a systematic random sampling method. The median waiting time during the pandemic period was significantly shorter than the previous year (median 14 min [IQR: 5–32] vs. median 5 min [IQR: 2–16]; p<0.001). The median duration of symptoms was 1 day (1–2) in both groups. Emergency Severity Index (ESI) levels I, II, and III showed a significant increase (27.7% vs. 37.3%) in triage scoring compared to levels IV and V (72.3% vs. 62.7%) during the pandemic period (p<0.001). The median cost per patient during the pandemic period was statistically higher compared to the previous year ($19.57 [19.57–40.50] vs. $25.34 [31.50–52.01]; p<0.001). Overall costs during the pandemic period had a 1.6-fold decline.

Conclusion

We highlighted the changes in an ordinary PED profile during an extraordinary period. A shift in ESI levels in a more emergent direction was observed. While the number of nonurgent patients, especially those with infections, decreased, the rates of surgical cases, acute neurological and heart diseases, home accidents, and poisoning increased relative to the pre-pandemic period.

Evaluation of the accuracy of immature granulocyte percentage in predicting pediatric serious bacterial infection

INTRODUCTION

Serious bacterial infections (SBI) are major causes of mortality and morbidity in children. The aim of this study was to determine the accuracy of the immature granulocyte (IG) percentage in predicting SBI.

METHODS

Patients admitted to the pediatric emergency department with fever were divided into two groups: with SBI and with non-SBI. White blood cell (WBC) count, absolute neutrophil count (ANC), C-reactive protein (CRP), and the percentage of IG value were recorded, and their accuracy in predicting SBI was evaluated.

RESULTS

Sixty-one (14.3%) patients fell into the SBI group and 367 (85.7%) were with non-SBI. Mean IG percentage among SBI patients was 0.84 ± 1.21 and 0.27 ± 0.20 for with non-SBI patients (P = .001). Based on disease, the highest IG percentage was found in patients diagnosed with sepsis (IG 3.7 ± 3.5%) and with bacterial meningitis (IG 1.6 ± 1.3%). The area under the curve (AUC) of IG percentage to predict SBI was 0.83 with 95% confidence interval (CI) [0.78-0.88]; WBC was 0.76 (95% CI 0.70-0.83); ANC was 0.73 (95% CI 0.67-0.80), and CRP was 0.79 (95% CI 0.73-0.85). When infection markers were compared to the most appropriate cut-off values in predicting SBI, IG percentage showed the highest sensitivity and specificity. When the cut-off value was determined as >0.35 for IG percentage, sensitivity was 75.4% and specificity was 76.6% in predicting SBI.

CONCLUSION

Patients with SBI had a higher IG percentage. Compared to other biomarkers, IG percentage had higher sensitivity and specificity in predicting SBI.

Thyroid abnormalities in survivors of childhood cancer

OBJECTIVE

To investigate the late side effects of childhood cancer therapy on the thyroid gland and to determine the risk factors for development of thyroid disorder among childhood cancer survivors.

METHODS

One hundred and twenty relapse-free survivors of childhood cancer (aged 6-30 years) were included in this study. The diagnoses of patients were lymphoma, leukemia, brain tumor, rhabdomyosarcoma and nasopharyngeal carcinoma (NPC). The patients were divided into two groups depending on the treatment: group 1-chemotherapy (ChT) only (n=52) and group 2-combination therapy of ChT + radiotherapy (RT) (head/neck/thorax) (n=68). Thyroid function tests, urinary iodine levels, and thyroid gland ultrasound examinations were evaluated in both groups.

RESULTS

Incidence of thyroid disease was 66% (n=79) in the survivors. The thyroid abnormalities were: hypothyroidism (HT) (n=32, 27%), thyroid nodules (n=27, 22%), thyroid parenchymal heterogeneity (n=40, 33%), autoimmune thyroiditis (n=36, 30%), and thyroid malignancy (n=3, 2%). While the incidence of HT and thyroid nodules in group 2 was significantly higher than in group 1, the incidence of thyroid parenchymal heterogeneity and autoimmune thyroiditis was similar in the two patient groups. HT and thyroid malignancy were seen only in group 2. In multivariate logistic regression analysis, a history of Hodgkin lymphoma (HL), brain tumor and NPC, as well as cervical irradiation and 5000-5999 cGy doses of radiation were found to constitute risk factors for HT. History of HL and 4000-5999 cGy doses of radiation were risk factors for thyroid nodules. Head/neck irradiation and treatment with platinum derivatives were risk factors for autoimmune thyroiditis. In univariate analysis, a history of NPC, cervical + nasopharyngeal irradiation, and treatment with platinum derivatives were risk factors for thyroid parenchymal heterogeneity.

CONCLUSION

Our results indicate that there is especially an increased risk of HT and thyroid nodules in patients treated with combination therapy of ChT with head/neck/thorax RT. Although chemotherapeutic agents per se do not seem to cause HT, longer follow-up is needed to assess whether or not there is an increased risk for autoimmune thyroiditis and thyroid parenchymal heterogeneity after antineoplastic therapy.