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BACKGROUND: Accurate and swift tissue diagnosis is extremely important for the timely initiation of treatment in pediatric oncology. In our department, ultrasound-guided core needle biopsy (US-guided CNB) is used for tissue diagnosis. In 2016, we added on-site cytology, allowing for an immediate primary diagnosis. We retrospectively reviewed our performance in terms of safety and accuracy for CNBs and on-site cytology. METHODS: All pediatric biopsies performed in our hospital between February 2016 and December 2020, were included. Patient clinical, procedural and follow-up data were collected. CNB pathology and cytology results were compared to the final pathologic diagnosis. RESULTS: We included 71 patients for which 72 biopsies with on-site touch imprint (TI) cytology were performed; the average latency time to biopsy was 1 day. Altogether, we had 61 tumors, (58 malignant, 3 benign) and 11 other lesions. On-site cytology diagnosed 58 malignant tumors, 3 benign tumors and 11 non-tumor tissues. The cytologist correctly differentiated tumor from inflammation in all cases, and diagnosed the precise tumor type in 57 cases, with an accuracy of 94% for final diagnosis. We had no complications related to the procedure or sedation. CONCLUSION: US-guided CNB with on-site TI cytology for suspected malignancy in the pediatric population is highly available, safe, and accurate, with real-time diagnosis in most cases. This accelerated diagnostic route has a huge impact on patient care.

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Pulmonary nodules present a diagnostic challenge when they appear as atypical metastases in pediatric oncology patients. Chest computed tomography (CT) is the primary imaging modality for assessing lung nodules. In pediatric populations, Wilms tumor and osteosarcoma are the cancers most likely to produce pulmonary metastasis, both typical and atypical. This pictorial essay provides a thorough description of the specific radiologic features of atypical pediatric pulmonary metastases, and their pathogenesis and differential diagnosis. We also address diagnostic approaches to incidental lung nodules in healthy children found in the literature. Our aim is to help radiologists identify atypical lung metastases on CT, ensuring that children receive prompt, and potentially lifesaving, treatment.

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OBJECTIVE: To assess whether children and youth with concussion receive follow-up visits in accordance with the recommended guidelines. STUDY DESIGN: We conducted a retrospective, population-based study using linked health administrative data from all concussion-related visits to emergency department and physician offices by children aged 5 through 18 years (range, 5.00-18.99) in Ontario between 2003 and 2013. We analyzed the percentage of children and youth seen for follow-up. The Mann-Kendall test for trends was used to assess a monotonic increasing trend over time in concussion follow-up visits. RESULTS: A total of 126 654 children and youth were evaluated for an index concussion visit. The number of children and youth assessed for concussion follow-up (N = 45 155) has increased significantly over time (P < .001). In 2003, 781 of 7126 patients (11.0%; 95% CI, 10.3-11.7) with an index visit for concussion had a follow-up assessment. By 2013, 6526 of 21 681 (30.1%; 95% CI, 29.5-30.7) patients received follow-up care. CONCLUSIONS: The proportion of children and youth receiving follow-up after an acute concussion has significantly increased between 2003 and 2013. Nevertheless, more than two-thirds of all patients do not seek medical follow-up or clearance as recommended by current concussion guidelines, suggesting that ongoing efforts to improve and monitor compliance with recommended guidelines by patients and physicians are important.

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BACKGROUND: There is a paucity of information regarding descriptive epidemiology of paediatric concussions over time, and few studies include both emergency department (ED) and physician office visits. OBJECTIVE: To describe trends in visits for paediatric concussions in both EDs and physician offices according to age and sex. A secondary objective was to describe the cause of concussion for children treated in EDs. METHODS: A retrospective, population-based study using linked health administrative data from all concussion-related visits to the ED or a physician office by school-age children and youth (three to 18 years of age) in Ontario between April 1, 2003 and March 3, 2011 was conducted. RESULTS: The number of children evaluated in both EDs and a physician offices increased between 2003 and 2010, and this linear trend was statistically significant (P=0.002 for ED visits and P=0.001 for office visits). The rate per 100,000 increased from 466.7 to 754.3 for boys and from 208.6 to 440.7 for girls during the study period. Falls accounted for approximately one-third of the paediatric concussions. Hockey/skating was the most common specific cause of paediatric sports-related concussions. CONCLUSIONS: The increasing use of health care services for concussions is likely related to changes in incidence over time and increased awareness of concussion as a health issue. Evidence-based prevention initiatives to help reduce the incidence of concussion are warranted, particularly in sports and recreation programs.

HISTORIQUE: On possède peu d'information sur l'épidémiologie descriptive des commotions cérébrales en pédiatrie au fil du temps, et rares sont celles qui portent à la fois sur les visites à l'urgence et au cabinet du médecin. OBJECTIF: Décrire les tendances des visites à l'urgence et au cabinet du médecin par une population d'âge pédiatrique en raison de commotions cérébrales, en fonction de l'âge et du sexe. Un objectif secondaire consistait à décrire la cause des commotions cérébrales chez les enfants traités à l'urgence. MÉTHODOLOGIE: Des chercheurs ont mené une étude rétrospective en population reliant les données administratives en matière de santé de toutes les visites d'enfants d'âge scolaire et d'adolescents (de trois à 18 ans) à l'urgence ou au cabinet du médecin en raison d'une commotion cérébrale en Ontario, entre le 1er avril 2003 et le 3 mars 2011. RÉSULTATS: Le nombre d'enfants évalués à l'urgence ou au cabinet du médecin a augmenté entre 2003 et 2010, et cette tendance linéaire était statistiquement significative (P=0,002 pour les visites à l'urgence et P=0,001 pour celles en cabinet). Pendant la période de l'étude, le taux sur 100 000 enfants est passé de 466,7 à 754,3 chez les garçons et de 208,6 à 440,7 chez les filles. Les chutes représentaient environ le tiers des commotions cérébrales en pédiatrie, tandis que le hockey ou le patin était la principale cause de commotions cérébrales liées au sport. CONCLUSIONS: L'utilisation croissante des services de santé en raison d'une commotion cérébrale est probablement liée à l'évolution de leur incidence et à une plus grande sensibilisation à leurs conséquences sur la santé. Il faudra entreprendre des initiatives de prévention fondées sur des données probantes pour contribuer à réduire l'incidence des commotions cérébrales, notamment dans le cadre des programmes sportifs et de loisirs.