How to interpret spinal imaging in paediatric trauma.

Spinal injuries in children are fortunately rare; however, it is important that they are assessed and managed in a timely manner. A systematic approach to traumatic spinal injuries should be used, by following recent evidence and national protocols, in order to avoid misinterpretation and potentially, inappropriate discharge. The aim of this article is to highlight the concepts of spinal imaging in paediatric trauma with regards to indications, interpretation and limitations.

Mortality in adolescent trauma: a comparison of children's, mixed and adult major trauma centres.

OBJECTIVE: We aimed to compare adolescent mortality rates between different types of major trauma centre (MTC or level 1; adult, children's and mixed). METHODS: Data were obtained from TARN (Trauma Audit Research Network) from English sites over a 6-year period (2012-2018), with adolescence defined as 10-24.99 years. Results are presented using descriptive statistics. Patient characteristics were compared using the Kruskal-Wallis test with Dunn's post-hoc analysis for pairwise comparison and χ2 test for categorical variables. RESULTS: 21 033 cases met inclusion criteria. Trauma-related 30-day crude mortality rates by MTC type were 2.5% (children's), 4.4% (mixed) and 4.9% (adult). Logistic regression accounting for injury severity, mechanism of injury, physiological parameters and 'hospital ID', resulted in adjusted odds of mortality of 2.41 (95% CI 1.31 to 4.43; p=0.005) and 1.85 (95% CI 1.03 to 3.35; p=0.041) in adult and mixed MTCs, respectively when compared with children's MTCs. In three subgroup analyses the same trend was noted. In adolescents aged 14-17.99 years old, those managed in a children's MTC had the lowest mortality rate at 2.5%, compared with 4.9% in adult MTCs and 4.4% in mixed MTCs (no statistical difference between children's and mixed). In cases of major trauma (Injury Severity Score >15) the adjusted odds of mortality were also greater in the mixed and adult MTC groups when compared with the children's MTC. Median length of stay (LoS) and intensive care unit LoS were comparable for all MTC types. Patients managed in children's MTCs were less likely to have a CT scan (46.2% vs 62.8% mixed vs 64% adult). CONCLUSIONS: Children's MTC have lower crude and adjusted 30-day mortality rates for adolescent trauma. Further research is required in this field to identify the factors that may have influenced these findings.

Using multifaceted education to improve management in acute viral bronchiolitis.

OBJECTIVE: To establish current bronchiolitis management across hospitals in Wales, improve compliance with national guidelines and standardise evidence-based clinical practice. DESIGN: A complete audit cycle with implementation of a multifaceted education bundle prior to the follow-up audit. SETTING: Twelve acute paediatric departments between 1 November and 31 December in 2012 and 2013. PATIENTS: All infants under 12 months with a clinical diagnosis of bronchiolitis. INTERVENTIONS: The first audit assessed management of bronchiolitis with reference to both the Scottish Intercollegiate Guideline Network (SIGN) guidelines and local hospital guidelines. Following analysis and dissemination of these results, an education bundle was implemented nationwide, with completion of the audit cycle to assess change. MAIN OUTCOME MEASURES: Compliance with SIGN recommendations for investigation, treatment and discharge. Compliance with the education bundle requirements also assessed in 2013. RESULTS: Data were collected for 1599 infants. The education bundle was delivered in all hospitals. The level of severity, defined by oxygen saturations in air at presentation, length of stay and paediatric intensive care unit transfers, was equivalent for both years. Mean compliance percentage (95% CI) across Wales significantly improved between 2012 and 2013, with compliance with investigations increasing from 50% (46% to 53%) to 71% (68% to 74%), with management increasing from 65% (61% to 68%) to 74% (71% to 77%), and overall compliance improving from 38% (37% to 39%) to 59% (56% to 62%) in 2013. CONCLUSIONS: This audit demonstrated a significant improvement in compliance following implementation of our educational bundle. This has enabled improvement in standardised and evidence-based patient care across Wales.