Current management in paediatric splenic trauma

s / Injury Extra 40 (2009) 139–146 141 Current management in paediatric splenic trauma D. Robinson *, J. Hamill Starship Children’s Hospital, Auckland, New Zealand Aim: There has been a recent shift in the management of paediatric splenic trauma, from surgical management to that of a more conservativenature. This audit aimed todetermine the current rates of splenectomy in a paediatric population following a traumatic injury. Methods: Retrospective review of all cases of splenic injury presenting to Starship Children’s Hospital over the 31 months from 1 December 2005 to 30 June 2008. Results: Over the above-mentioned timeperiod, therewere a total of 36 patients between the ages of 0 and 14 with a coded diagnosis of Splenic Injury. Only one splenectomy was carried out at our institution and all other cases of splenic injury secondary to trauma weremanaged conservatively, giving an overall rate of splenectomy of 2.8%. The median age at presentation was 8.5 years, the most common mechanism of injury was sporting accidents, the median haemoglobin at admission was 123 g/l and the median lowest haemoglobin during admission was 112. 8 g/l out of the 36 patients were transfused with red blood cells. No patients received an ultrasound scan only, 30 patients received a CT scan only and 6 patientsunderwentboth.Themedian lengthofstay inhospitalwas5 days. Conclusions: Splenic trauma in the paediatric population is a relatively common occurrence. This audit shows the trend towards conservative management in recent years. Surgery can be safely avoided in the majority of children suffering a splenic injury, and need only be performed in multi-trauma patients with multiple sources of bleeding. doi: 10.1016/j.injury.2009.03.025 Child restraint system use in vehicles in Victoria, Australia C. Bevan , C. Palmer , V. Gorman *, C. Officer b a Trauma Service, Emergency Department, Royal Childrens Hospital, Melbourne, Australia b Trauma Service, Royal Childrens Hospital, Melbourne, Australia Background: Motor vehicle collisions comprise a significant proportion of the injury burden in children. Extensive studies have shown that inappropriate use of child restraint systems (CRS) contributes to increased risk of injury and death. However, Australian legislation regarding CRS use is incomplete and inconsistent, and there is evidence to suggest that parents remain uninformed regarding appropriate CRS. Objective: To review the use, and carers’ knowledge of CRS in children attending The Royal Children’s Hospital Melbourne. Method: A cross-sectional prospective survey was given to parents whose children were visiting the outpatient or emergency departments. Results: 213 surveys including 299 childrenwere completed. 82% of children had been correctly restrained on the day of attendance, but 13% had been placed in a CRS inappropriate to their weight. Within specific age groups, up to 24% of children had been placed in a CRS designed for heavier children, including 14% of infants weighing <8 kg. 37 patients (12%) were travelling as front seat passengers, with 11% of these weighing less than the recommended <26 kg. While 38% of carers had received a Victorian Roads Corporation booklet on appropriate CRS use, comparison with the other survey respondents didnot showadifference in CRS knowledge or practice. Conclusion: Although most children are appropriately restrained, a significant proportion are not. A lack of parental knowledge regarding CRS is evident. Based on these findings, we believe that a coordinated education campaign with improved guidance for parents, and consistency and specificity in Australian CRS legislation is a necessity. doi: 10.1016/j.injury.2009.03.026 The role of CT in the head-injured child: A Royal Children’s Hospital Melbourne perspective V. Gorman *, C.S. Palmer Trauma Service, Royal Children’s Hospital Melbourne, Australia Background: Head injury is a common presentation amongst children. The ability to use clinical predictors to identify children with Intracranial Injury (ICI) has been evaluated by numerous researchers. However, rates of CT use to detect ICI, both in practice and algorithm prediction, vary widely. Objective: To review CT imaging rates in the head-injured population presenting to the Royal Children’s Hospital Melbourne (RCH) relative toactual andpredicted rates generatedbyprevious research. Methods: Patients presenting to RCHwith a history of head trauma between 2005 and 2007 were reviewed. Outcomes evaluated included the presence of any pathology (ICI or skull fracture), admission or neurosurgical intervention. A subset of patients with mild presenting symptoms (GCS 14–15) was also analysed. Results: 4267 patients presented without prior CT; 741 (17%) had CT scans performed. 3054 children were discharged from ED within 4hrs; 4% of these had a CT scan including 2 with diagnosed skull fracture. 1213 patients were subsequently admitted; 52% had CT, of which 250 patients (40%) had pathology. Amongst 844 admissions with GCS 14 or 15 on arrival, 453 (54%) had CT, of whom 34% had pathology. A total of 58 patients required neurosurgical intervention, and eight died. Three patients had missed pathology; none had adverse outcome. Conclusions: As a leading children’s hospital, great importance should be given to evidence based practice. Although RCH CT imaging rates appear higher than in published literature, current practice in the use of CT to detect head injury has a high sensitivity for pathology detection. doi: 10.1016/j.injury.2009.03.027 The true spectrum of handlebar injuries in children C. Palmer *, S. Arul , J. Crameri a,c Royal Children’s Hospital Melbourne, Australia Department of Paediatric Surgery, Birmingham Children’s Hospital, United Kingdom Department of General Surgery, The Royal Children’s Hospital Melbourne, Australia Objective: The full spectrum and incidence of injuries caused by handlebar impact in children has not been adequately described in the literature. While bicycle handlebars are known to cause significant intra-abdominal injury, there are a number of other vehicle types using handlebars which have not been fully explored for the incidence and severity of handlebar trauma. Method: prospectively identified trauma registry was searched for all trauma events relating to vehicles equipped with handlebars from July 2000 through June 2008. Patients with injuries involvinghandlebar impactwere identifiedand studied in greater detail. Results: Of 1565 traumas identified, there were 179 children with a handlebar injury. Bicycles were the most common vehicle used (78%), followed by motorbikes (12%), scooters and quadbikes. While the majority of ‘handlebar’ children had abdominal impact (63%), a significant number of traumas involved impact to other regions including the face (12%), thigh, perineum, neck and chest. Patient age and vehicle type were associated; in children riding scooters, the most common site of handlebar impact was the face