Telehealth has been utilized to provide convenient and effective care in the outpatient setting and emergency consultations for outside hospitals. In the setting of the COVID-19 pandemic many hospitals rapidly expanded telemedicine usage to incorporate inpatient pediatric care in order to reduce the risk of transmission. While hospitals rapidly expanded their use of telehealth throughout inpatient care, it remains unknown how the use of inpatient telehealth will continue moving forward post-pandemic. After nearly a year of incorporation in this setting, we are now capable of establishing a better idea of the benefits and limitations of telemedicine for inpatient pediatrics. For this study, we conducted a single-site qualitative interview guide based on questions that focused on 3 major topics: (1) use of inpatient telehealth during COVID-19, (2) potential uses of inpatient telehealth after COVID-19, (3) and strategies to optimize inpatient telehealth after COVID-19. Interviews were conducted via zoom video conference and were audio recorded and transcribed. Transcripts were then open coded and used for interpretation. Interviewees consisted of health care providers in the department of pediatrics that have used telehealth within two weeks prior to the interview. Limitations were found in categories of efficiency, patient-provider interaction, and technology. The largest barrier to future adoption revolved around the time it takes to coordinate telemedicine and the time it takes to round while using telemedicine. Benefits were found to include efficiency, patient-provider interaction, and technology in addition to the risk reduction it was primarily being used for at the time. It is evident through interview responses that if leveraged successfully, telemedicine has the potential to expand patient care. One way is by allowing increased access to the supervising physician of the primary team and specialist outside of the normal work week hours in turn preventing delay in treatment and diagnostic care. The expansion of care also extends to the convenience of access to patients and families, including those that cannot be readily available at bedside.

Introduction: Traumatic brain injury (TBI) is frequently encountered in geriatric patients, but there is a paucity of data describing TBI in the elderly. Here, we show the age of patients with TBI is increasing at our medical center and discuss the relationship between age and injury severity with patient outcomes. Methods: This is a retrospective analysis of 3,179 adult patients with TBI treated at the University of California, Davis Level 1 Trauma Center between 2009 and 2016. Age, Glasgow Coma Scale (GCS), and CT Rotterdam Scores were recorded. Age was analyzed as both a continuous and categorical variable (18-34, 35-50, 51-65, >65 years-old). Extended Glasgow Outcome Scale was obtained at 3 and 6 months and dichotomized into favorable and unfavorable outcomes. Multivariable general linear regression models, chi-square, logistic regression analyses and ANOVA were used for statistical analyses; a p < 0.05 was considered significant. Results: The mean age of patients was 52.2 ± 21.9 years with a male predominance (69%). There was a significant trend (p = 0.002) toward an increase in mean age each year, increasing by 4.4 years (p = 0.008) over the course of the analysis. Older patients had a higher mean GCS compared to younger patients with the same CT Rotterdam Score (p = 0.027), this becoming more pronounced with worse CT Rotterdam Scores. The >65 group had a 4-fold increased risk for unfavorable outcome when compared to the 18-34 group, this effect being most pronounced after mild TBI. Conclusions: The mean age of TBI patients is increasing at our trauma center. The largest disparity in outcomes across age was seen in patients with a mild GCS and low CT Rotterdam Scores, suggesting that these markers of injury severity may underestimate the severity of injury in the elderly population. This information highlights the need for clinical trials and validation of outcome markers in geriatric TBI.

Background  Exostoses and osteomas are benign, insidious lesions of the bone involving the internal acoustic canal (IAC). We present two cases of IAC exostoses managed with surgical decompression and review the clinical outcomes of previously reported cases in the literature. Methods  A comprehensive search was conducted using PubMed Central, Web of Science Core Collection, and Google Scholar databases to identify previous reports of IAC exostoses and osteomas. A total of 26 reported cases were identified, and patient presenting symptoms, management strategies, and response to surgery was obtained when available. Results  Of the 13 patients who underwent surgical decompression, 8 patients had resolution of vertigo symptoms, 10 patients had improvement of tinnitus symptoms, and all patients maintained some level of serviceable hearing. Conclusion  IAC exostoses and osteomas are rare lesions that lead to insidious onset of debilitating symptoms from vestibulocochlear nerve dysfunction. Although the role of surgical decompression remains unclear, it appears that patients presenting with vertigo have more favorable response to surgical decompression as compared with those presenting with tinnitus and sensorineural hearing loss.