Anergy in pediatric head trauma patients

Article Abstract:

Infection is a common complication of severe trauma and is a major cause of extra hospitalization and death. Patients who have sustained major blunt trauma have been found to have a suppressed immune system, which contributes to the occurrence of secondary infection. Blunt trauma is frequent in children, and while the immune system of children differs from that of adults, changes in its function following severe injury have not been well-studied. Immune system function was studied in 25 children, aged 2 to 14, who were hospitalized in intensive care for major trauma. Infections occurred in 14 children, and three patients died. Skin tests of delayed-type hypersensitivity (DTH) reactions to common bacterial antigens (molecules provoking immune responses) were used as initial indicators of immune function; 14 patients were anergic (absence of immune system reactivity), and these children were significantly more likely to develop infections. Non-anergic trauma patients had significantly fewer positive skin tests than did 10 control children with minor disorders. Specific changes in patient subgroups of lymphocytes, important infection-fighting white blood cells, were also studied. Among another group of 10 children, aged 2 months to 14 years and hospitalized with major head trauma, there was a significant decrease in levels of B lymphocytes, but not T lymphocytes, in the first week following injury. The study indicates that unlike adults with trauma injuries, children similarly injured sustain decreases in B lymphocytes, but not T lymphocytes. Use of the DTH skin test should be helpful in identifying patients at risk for infection and allow treatment focused at preventing infections in these patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Testing, Complications and side effects, Physiological aspects, Wounds and injuries, Immune response, Immune system, Immunologic tests

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Head injury training for pediatric residents

Article Abstract:

Recently it has been recommended that pediatricians become involved in the long-term follow-up of children who have had mild to moderate head injuries. These injuries can result in persistent physical as well as psychosocial and cognitive effects. The pediatrician is the specialist best able to work with school staff in serving these children and to translate medical data and advise on long-term rehabilitation. Because of this it is important to know how well pediatricians have been trained concerning head injuries. One hundred and ten pediatric residency program directors were surveyed about the scope and depth of training that is provided in their program regarding head injury. The results indicated that 60 percent of the programs trained residents in prevention and acute care of head injury. About half of the programs did not go beyond this. Education about the long-term effects of head trauma was very limited, and usually the level of this knowledge was not even evaluated. Pediatricians need to be aware of the long-term consequences of head injury. They should involve the rehabilitation specialists early in the child's treatment so that rehabilitation planning can be initiated promptly. (Consumer Summary produced by Reliance Medical Information, Inc.)

Study and teaching, Head injuries

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Insurance coverage and residents' experience in a pediatric teaching clinic

Article Abstract:

The existence and type of insurance coverage may affect the range of illnesses seen by pediatric residents and therefore their training. A study examined the relationship between a patient's medical insurance coverage and the diagnosis given for 6,543 children treated at two pediatric teaching clinics. The patients seen at the clinics were classified into one of four health insurance situations: indemnity insurance, health maintenance organization (HMO) coverage, Medicaid or no insurance. Different types of medical problems were more common among patients with certain types of medical insurance coverage. For example, Medicare and Medicaid patients were more likely to be seen for diabetes and high blood pressure. Those with HMO coverage were more often seen for gynecological and obstetric problems. The ages of patients as well as their medical problems differed by insurance coverage. Children over two years old with no health insurance were less likely to visit a clinic for treatment than those with some form of health insurance. Despite these differences, the residents still saw a broad range of patients.

Health aspects, Health insurance, Residents (Medicine)

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