Epidemiology of paediatric injuries in Nepal: evidence from emergency department injury surveillance.

BACKGROUND: Globally, injuries cause >5 million deaths annually and children and young people are particularly vulnerable. Injuries are the leading cause of death in people aged 5-24 years and a leading cause of disability. In most low-income and middle-income countries where the majority of global child injury burden occurs, systems for routinely collecting injury data are limited. METHODS: A new model of injury surveillance for use in emergency departments in Nepal was designed and piloted. Data from patients presenting with injuries were collected prospectively over 12 months and used to describe the epidemiology of paediatric injury presentations. RESULTS: The total number of children <18 years of age presenting with injury was 2696, representing 27% of all patients presenting with injuries enrolled. Most injuries in children presenting to the emergency departments in this study were unintentional and over half of children were <10 years of age. Falls, animal bites/stings and road traffic injuries accounted for nearly 75% of all injuries with poisonings, burns and drownings presenting proportionately less often. Over half of injuries were cuts, bites and open wounds. In-hospital child mortality from injury was 1%. CONCLUSION: Injuries affecting children in Nepal represent a significant burden. The data on injuries observed from falls, road traffic injuries and injuries related to animals suggest potential areas for injury prevention. This is the biggest prospective injury surveillance study in Nepal in recent years and supports the case for using injury surveillance to monitor child morbidity and mortality through improved data.

The unfulfilled potential of point-of-care ultrasound (POCUS) in paediatric emergency medicine (PEM) training

BackgroundPoint-of-care ultrasound (POCUS) has been an essential component of The Royal College of Emergency Medicine’s higher speciality curriculum since 2010. However, it has only been part of the Paediatric Emergency Medicine (PEM) syllabus since 2018, with its use less well-embraced by the specialty. In comparison, POCUS has become increasingly established in PEM departments across North America, with widespread evidence supporting its diagnostic and procedural application in PEM. These successful practices highlight the potential for POCUS to be further implemented within PEM departments in the UK.ObjectivesThe absence of a standardised PEM-specific POCUS training program in the UK led us to suspect a possible wide disparity in the training and delivery of POCUS among PEM clinicians. Following on from the 2019 PERUKI study, which aimed to determine the current implementation and practices of POCUS in various PEM departments, we decided to focus in on and survey a cohort of trainees to evaluate their current opinions, experiences and attitudes towards POCUS in PEM.MethodsWe created an online survey and distributed it in October 2020 to a sample of trainees from our tertiary paediatric site. The survey questions not only ascertained variation in POCUS experience and formal training, but had a novel focus in targeting the barriers to its more frequent implementation as well as the attitudes of the trainees towards the future of POCUS in PEM education.ResultsWe received a 56% response rate from the trainees invited to participate in the survey. Our results confirmed a deficiency in the standardised POCUS training amongst the PEM clinicians, with 89% having no PEM-specific POCUS training. We observed an underuse of POCUS at our site, with 76.9% stating they have ‘never’ used POCUS for diagnostic purposes. Despite this, >60% agreed with the statement that ‘POCUS is a necessary addition to PEM’, with zero disagreement. 100% of trainees voted that they would like further teaching, recognising the need for the development of a PEM-specific training curriculum before they can confidently utilise it in their day to day practice. 100% of the trainees believe that POCUS should be taught to postgraduates, 67% to undergraduates.ConclusionsThe results of our survey have emphasised the need for a PEM-specific POCUS training pathway in the UK. We confirmed that the severe underuse in POCUS application was not due to a lack of enthusiasm, but rather a lack of training. The large majority of our respondents believe POCUS to be an essential adjunct to paediatric emergency medicine, however its user-dependency in the absence of well-established training severely restricts its potential as a diagnostic and procedural tool. Given current circumstances, an endeavour into implementing standardised teaching in postgraduate training would be worthwhile. The role of POCUS could prove useful in this COVID era, such as the potential to reduce clinician’s exposure to the virus in the examination of COVID lung pathologies.