Epidemiology of paediatric drowning hospitalisations in the USA: a population-based study

Theodorou CM, Rajasekar G, McFadden NR, Brown EG, Nuño M

Drowning is a leading cause of death in children ≤5 years old. Detailed data on the epidemiology of drowning in this high-risk population can inform preventative efforts. We aimed to study trends in incidence and case fatality rates (CFR) in the USA among young children hospitalised after drowning. Among 30 560 804 hospitalised children ≤5 years old, 9261 drowning cases were included. The study allowed to conclude that Hospitalisations and CFRs for drowning among children ≤5 years old have decreased from 2000 to 2016. Two years old are at the highest risk of both fatal and non-fatal drowning. Disparities exist for Black children in both the relative reduction in drowning hospitalisation incidence and case fatality. Interventions should focus on providing equitable preventative care measures to this population.

Increased mortality in very young children with traumatic brain injury due to abuse: A nationwide analysis of 10,965 patients

Theodorou CM, Nuño M, Yamashiro KJ, Brown EG

Traumatic brain injury (TBI) is the leading cause of death and disability in young children; however, the impact of mechanism on outcomes has not been fully evaluated. We hypothesized that children with TBI due to abuse would have a higher mortality than children with accidental TBI due to motor vehicle collisions (MVC). We performed a retrospective review of the National Kids’ Inpatient (KID) hospitalizations database of children <2 years old with TBI due to abuse or MVC (2000–2016). The study allowed to conclude that Children with abusive traumatic brain injury have increased risk of mortality, longer LOS, and higher hospital charges compared to children with TBI due to motor vehicle collision after adjusting for relevant confounders. Resources must be directed at prevention and early identification of abuse.

Long-term impact of abusive head trauma in young children

Nuño M, Ugiliweneza B, Veronica Zepeda V, Anderson JE, Coulter K, Magana JN, Drazin D, Boakye M

Abusive head trauma is the leading cause of physical abuse deaths in children under the age of 5 and is associated with severe long-lasting health problems and developmental disabilities. This study evaluates the long-term impact of AHT and identifies factors associated with poor long-term outcomes (LTOs). We used the Truven Health MarketScan Research Claims Database (2000–2015) to identify children diagnosed with AHT and follow them up until they turn 5. This study allowed to conclude that AHT is associated with a significant long-term disability (72%). Children insured by Medicaid have a disproportionally higher risk of long-term disability. Efforts to identify and reduce barriers to health care access for children enrolled in Medicaid are critical for the improvement of outcomes and quality of life.

Multiple Spinal CSF Leaks in Spontaneous Intracranial Hypotension: Do They Exist?

Schievink WI, Maya MM, Moser F, Prasad R, Wadhwa V, Cruz R, Nuño M

This observational study was conducted to determine the frequency of multiple spinal CSF leaks in a recent group of patients with spontaneous intracranial hypotension (SIH) who were investigated with digital subtraction myelography (DSM). The data came from a prospectively maintained data base of patients who meet the International Classification of Headache Disorders, third edition, criteria for SIH. The patient population consisted of a consecutive group of 745 patients with SIH who underwent DSM between March 2009 and February 2020. Based on the results of DSM, participants were classified according to the type and number of spinal CSF leaks. Among patients with SIH, multiplicity of CSF leaks was observed radiographically in none of the patients with ventral leaks, in 6% of patients with lateral leaks, and in 9% of patients with CSF-venous fistulas. These results suggest that patients with SIH can be reassured that the occurrence of multiple CSF leaks is negligible to uncommon at most, depending on the type of CSF leak.

Long-term Risks of Persistent Ventral Spinal CSF Leaks in SIH: Superficial Siderosis and Bibrachial Amyotrophy

Schievink WI, Maya M, Moser F, Nuño M

Superficial siderosis, bibrachial amyotrophy, and spinal cord herniation are unusual but serious long-term sequelae of persistent spontaneous spinal CSF leaks in patients with spontaneous intracranial hypotension (SIH), particularly ventral spinal CSF leaks. However, the risk of developing such sequelae has not been established in this population. We undertook this study to determine the risk of these serious complications of persistent ventral spinal CSF leaks. This cohort study was conducted using data from a prospectively maintained database of patients who meet the modified International Classification of Headache Disorders, 3rd edition criteria for SIH. Among patients with SIH and a persistent ventral spinal CSF leak, the risk of developing serious long-term sequelae is considerable. This study shows that early treatment of a ventral spinal CSF leak offers a unique opportunity to prevent neurologic disability from superficial siderosis and bibrachial amyotrophy.

Computed Tomography vs Heavily T2-Weighted Magnetic Resonance Myelography for the Initial Evaluation of Patients With Spontaneous Intracranial Hypotension

Tay ASS, Maya M, Moser FG, Nuño M, Schievink WI

This study compares the diagnostic accuracy of magnetic resonance myelography with computed tomography myelography for the identification of spinal cerebrospinal fluid leaks.

Spontaneous spinal cerebrospinal fluid-venous fistulas in patients with orthostatic headaches and normal conventional brain and spine imaging

Schievink WI, Maya M, Prasad RS, Wadhwa VS, Cruz RB, Moser FG, Nuño M

Spontaneous spinal CSF leaks cause orthostatic headaches but their detection may require sophisticated spinal imaging techniques. A prospective cohort study was conducted to patients with orthostatic headaches and normal brain and conventional spine imaging who underwent digital subtraction myelography (DSM) to look for CSF-venous fistulas, between May 2018 and May 2020, at a quaternary referral center for spontaneous intracranial hypotension. This study allowed to conclude that concerns about a spinal CSF leak should not be dismissed in patients suffering from orthostatic headaches when conventional imaging turns out to be normal, even though the yield of identifying a CSF-venous fistula is low.

Incidence of spontaneous intracranial hypotension in a community: Beverly Hills, California, 2006-2020

Schievink WI, Maya MM, Moser FG, Simon P, Nuño M

Spontaneous intracranial hypotension is diagnosed with an increasing frequency, but epidemiologic data are scarce. The aim of this study was to determine the incidence rate of spontaneous intracranial hypotension in a defined population. Using a prospectively maintained registry, all patients with spontaneous intracranial hypotension residing in Beverly Hills, California, evaluated at our Medical Center between 2006 and 2020 were identified in this population-based incidence study. This study, for the first time, provides incidence rates for spontaneous intracranial hypotension in a defined population.