Development of a surrogate bruising detection system to describe potential bruising patterns associated with common childhood falls.

Child abuse is a leading cause of fatality in children aged 0-4 years. An estimated 1,700 children die annually as a result of child abuse of which threequarters (75.7%) of the children were younger than 4 years old1. Infants (younger than 1 year) had the highest rate of fatalities among the group. Many of the serious injuries and fatalities could have potentially been prevented if clinicians and child protective services were able to better distinguish between injuries associated with abuse versus those caused by accidents. Missed cases of child abuse have been shown to be as high as 71% of all admitted cases, where children are presented at hospitals for their injuries and not evaluated as being abused 2. Additionally, when child abuse is legally pursued for criminal charges, a little more than half of the cases move forward to prosecution as opposed to being screened out for reasons including the need for further investigation or insufficient evidence 3. Therefore there is a need to provide clinicians, child protective services and law enforcement personnel with improved knowledge related to the types of injuries that are possible from common household accidents that are often reported to be the underlying cause of injury in child abuse. Bruising is an early sign of abuse, and can be an effective indicator of child abuse. Although not life threatening, bruising injuries or bruising patterns provide a “roadmap” documenting a child’s exposure to impact. Previous research has relied upon the use of instrumented anthropomorphic test devices, or test dummies, to investigate injury risk in common childhood falls and accidents in addition to head injury and bone fracture risk in children 4-7. However, the ability to predict bruising patterns occurring in association with falsely reported events in child abuse does not exist, and could prove extremely useful in the distinction between abusive and accidental injuries. This study required the modification of an existing pediatric test dummy to allow for the prediction of potential bruising locations and bruising patterns in children during common household fall events that are often stated as false scenarios in child abuse. The scope of this project included the development of a “sensing skin” that was adapted to a commercial pediatric test dummy. This modified test dummy was then used in mock laboratory experiments replicating common household injury events while the “sensing skin” measured and recorded levels of impact force and locations of impact on the human surrogate. The data from the “sensing skin” was acquired and compiled in a computerized visual body map image displaying the areas of contact or impact locations. This body map image provided a “roadmap” of the human surrogate’s contact exposure during the specific fall event and defined a compatible impact roadmap–specific event combination. Impact roadmap–event combinations for various common household falls provide an indication of where potential bruising could occur. This knowledge of potential bruising patterns could aid clinicians in distinguishing between abusive and accidental injuries for specific fall types

Safety and tolerability of continuous inhaled iloprost in critically ill pediatric pulmonary hypertension patients: A retrospective case series

Abstract Inhaled iloprost (iILO) has shown efficacy in treating patients with hypoxic lung disease and pulmonary hypertension, inducing selective pulmonary vasodilation and improvement in oxygenation. However, its short elimination half‐life of 20–30 min necessitates frequent intermittent dosing (6–9 times per day). Thus, the administration of iILO via continuous nebulization represents an appealing method of drug delivery in the hospital setting. The objectives are: (1) describe our continuous iILO delivery methodology and safety profile in mechanically ventilated pediatric pulmonary hypertension patients; and (2) characterize the initial response of iILO in these pediatric patients currently receiving iNO. Continuous iILO was delivered and well tolerated (median 6 days; range 1–94) via tracheostomy or endotracheal tube using the Aerogen® mesh nebulizer system coupled with a Medfusion® 400 syringe pump. No adverse events or delivery malfunctions were reported. Initiation of iILO resulted in an increase in oxygen saturation from 81.4 ± 8.6 to 90.8 ± 4.1%, p 1 day resulted in a higher response rate to iILO (as defined as a ≥ 4% increase in saturations) compared to those receiving iNO <1 day (85% vs. 50%, p = 0.06). When the use of iILO is considered, continuous delivery represents a safe, less laborious alternative and concurrent treatment with iNO should not be considered a contraindication. However, given the retrospective design and small sample size, this study does not allow the evaluation of the efficacy of continuous iILO on outcomes beyond the initial response. Thus, a prospective study designed to evaluate the efficacy of continuous iILO is necessary