INTRODUCTION: Head injuries occur commonly in children and can lead to concussion injuries. We aim to describe the epidemiology of head injuries among school-going children and identify predictors of brain concussions in Singapore. METHODS: This is a retrospective study of children 7-16 years old who presented to the Emergency Department (ED) of KK Women's and Children's Hospital in Singapore with minor head injury between June 2017 and August 2018. Data including demographics, clinical presentation, ED and hospital management were collected using a standardised electronic template. Multivariable logistic regression analysis was performed to identify early predictors for brain concussion. Concussion symptoms were defined as persistent symptoms after admission, need for inpatient intervention, or physician concerns necessitating neuroimaging. RESULTS: Among 1,233 children (mean age, 6.6 years; 72.6% boys) analysed, the commonest mechanism was falls (64.6%). Headache and vomiting were the most common presenting symptoms. A total of 395 (32.0%) patients required admission, and 277 (22.5%) had symptoms of concussion. Older age (13-16 years old) (adjusted odds ratio [aOR] 1.53, 95% confidence interval [CI] 1.12-2.08), children involved in road traffic accidents (aOR 2.12, CI 1.17-3.85) and a presenting complaint of headache (aOR 2.64, CI 1.99-3.50) were significantly associated with symptoms of concussion. CONCLUSION This study provides a detailed description of the pattern of head injuries among school-going children in Singapore. High risk patients may require closer monitoring to detect post-concussion syndrome early.

Henoch-Schönlein purpura (HSP) is the commonest vasculitis in children, typically affecting children aged three to ten years.[1] It is a multi-systemic vasculitis mediated by type III hypersensitivity with deposition of immunoglobulin. An immune complex-mediated vasculitis affects small vessels of the skin, joints, kidneys, and gastrointestinal (GI) tracts. HSP is usually a self-limiting condition and resolves within six to eight weeks.[1] HSP tends to involve the GI tract and symptoms may occur before skin manifestations. Proximal small bowel and distal ileum are the sites that usually involved.[2,3] Colicky abdominal pain is the predominant GI manifestation and can be debilitating. Severe GI complications such as massive GI bleeding, intussusception, protein losing enteropathy, and pancreatitis can uncommonly occur.[2,4] Imaging is often required in the evaluation of HSP with GI involvement. However, there is little pediatric literature on the role of point-of-care ultrasound (POCUS) by pediatric emergency physicians in the identification of pneumatosis intestinalis (PI) in HSP.