Fractures of the femoral shaft in children

Aims The aim of this study was to describe the epidemiology of closed isolated fractures of the femoral shaft in children, and to compare the treatment and length of stay (LOS) between major trauma centres (MTCs) and trauma units (TUs) in England. Patients and Methods National data were obtained from the Trauma and Audit Research Network for all isolated, closed fractures of the femoral shaft in children from birth to 15 years of age, between 2012 and 2015. Age, gender, the season in which the fracture occurred, non-accidental injury, the mechanism of injury, hospital trauma status, LOS and type of treatment were recorded. Results A total of 1852 fractures were identified. The mean annual incidence was 5.82 per 100 000 children (95% confidence interval (CI) 5.20 to 6.44). The age of peak incidence was two years for both boys and girls; this decreased with increasing age. Children aged four to six years treated in MTCs were more likely to be managed with open reduction and internal fixation compared with those treated in TUs (odds ratio 3.20; 95% CI 1.12 to 9.14; p = 0.03). The median LOS was significantly less in MTCs than in TUs for children aged between 18 months and three years treated in both a spica (p = 0.005) and traction (p = 0.0004). Conclusion This study highlights the current national trends in the management of closed isolated fractures of the femoral shaft in children following activation of major trauma networks in 2012. Future studies focusing on the reasons for the differences which have been identified may help to achieve more consistency in the management of these injuries across the trauma networks. Cite this article: Bone Joint J 2018;100-B:109–18.

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Imaging the infant with a head injury: a single-centre retrospective study

BMJ Paediatrics Open ◽

10.1136/bmjpo-2020-000779 ◽

2020 ◽

Vol 4 (1) ◽

pp. e000779

Author(s):

Daniel Braunold ◽

Hannah Lewis ◽

Breda O'Neill ◽

Naomi Edmonds

Keyword(s):

Retrospective Study ◽

Head Injury ◽

Major Trauma ◽

Risk Group ◽

Trauma Centre ◽

High Risk Group ◽

Single Centre ◽

Accidental Injury ◽

Major Trauma Centre ◽

Non Accidental Injury

Head injury is the largest cause of mortality in paediatric trauma. Infants (<1 year old) are a high-risk group and vulnerable to non-accidental injury. A single-centre retrospective study at a major trauma centre collected data on infants presenting with a head injury over a 48-month period. 1127 infants presented with a head injury. 135 CT heads were performed. 38% of scans showed intracranial pathology. The decision about which infants to send for CT scans remains complex. Liberal use risks over-exposure to ionising radiation while restrictive use may miss subtler injuries.

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Major trauma in non-accidental injury

Archives of Disease in Childhood ◽

10.1136/archdischild-2021-322969 ◽

2021 ◽

pp. archdischild-2021-322969

Author(s):

Helen Stewart ◽

Sarah Stibbards ◽

Victoria Currie

Keyword(s):

Major Trauma ◽

Accidental Injury ◽

Non Accidental Injury

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A 10-YEAR DEMOGRAPHIC COMPARISON OF MAJOR TRAUMA AS A RESULT OF NON-ACCIDENTAL INJURY VERSUS ACCIDENTAL INJURY IN THE UK

Emergency Medicine Journal ◽

10.1136/emermed-2015-205372.58 ◽

2015 ◽

Vol 32 (12) ◽

pp. 1004.2-1005

Author(s):

F Davies ◽

T Coats ◽

FE Lecky

Keyword(s):

Major Trauma ◽

Accidental Injury ◽

The Uk ◽

Non Accidental Injury

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Prehospital tranexamic acid shortens the interval to administration by half in Major Trauma Networks: a service evaluation

Emergency Medicine Journal ◽

10.1136/emermed-2018-208118 ◽

2019 ◽

pp. emermed-2018-208118 ◽

Cited By ~ 1

Author(s):

Max E R Marsden ◽

Andrea Rossetto ◽

Charles A B Duffield ◽

Thomas G D Woolley ◽

William P Buxton ◽

...

Keyword(s):

Tranexamic Acid ◽

Major Trauma ◽

Service Evaluation ◽

Research Network ◽

Trauma Patients ◽

Nice Guidelines ◽

Trauma Registries ◽

Trauma Networks ◽

Local Trauma ◽

Patients At Risk

IntroductionTranexamic acid (TXA) reduces bleeding and mortality. Recent trials have demonstrated improved survival with shorter intervals to TXA administration. The aims of this service evaluation were to assess the interval from injury to TXA administration and describe the characteristics of patients who received TXA pre-hospital and in-hospital.MethodsWe reviewed Trauma and Audit Research Network records and local trauma registries to identify patients of any age that received TXA at all London Major Trauma Centres and Queen’s Medical Centre, Nottingham, during 2017. We used the 2016 NICE Guidelines (NG39) which state that TXA should be given within 3 hours of injury.ResultsWe identified 1018 patients who received TXA, of whom 661 (65%) had sufficient data to assess the time from injury to TXA administration. The median interval was 74 min (IQR: 47–116). 92% of patients received TXA within 3 hours from injury, and 59% within 1 hour. Half of the patients (54%) received prehospital TXA. The median time to TXA administration when given prehospital was 51 min (IQR: 39–72), and 112 min (IQR: 84–160) if given in-hospital (p<0.001). In-hospital TXA patients had less haemodynamic derangement and lower base deficit on admission compared with patients given prehospital TXA.ConclusionPrehospital administration of TXA is associated with a shorter interval from injury to drug delivery. Identifying a proportion of patients at risk of haemorrhage remains a challenge. However, further reinforcement is needed to empower pre-hospital clinicians to administer TXA to trauma patients without overt signs of shock.

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Age and the distribution of major injury across a national trauma system

Age and Ageing ◽

10.1093/ageing/afz151 ◽

2019 ◽

Vol 49 (2) ◽

pp. 218-226

Author(s):

Jan Robert Dixon ◽

Fiona Lecky ◽

Omar Bouamra ◽

Paul Dixon ◽

Faye Wilson ◽

...

Keyword(s):

Older Patients ◽

Major Trauma ◽

National Level ◽

Trauma System ◽

Injured Patient ◽

Healthcare Services ◽

Research Network ◽

Trauma Patients ◽

Significant Burden ◽

Trauma Networks

Abstract Background Trauma places a significant burden on healthcare services, and its management impacts greatly on the injured patient. The demographic of major trauma is changing as the population ages, increasingly unveiling gaps in processes of managing older patients. Key to improving patient care is the ability to characterise current patient distribution. Objectives There is no contemporary evidence available to characterise how age impacts on trauma patient distribution at a national level. Through an analysis of the Trauma Audit Research Network (TARN) database, we describe the nature of Major Trauma in England since the configuration of regional trauma networks, with focus on injury distribution, ultimate treating institution and any transfer in-between. Methods The TARN database was analysed for all patients presenting from April 2012 to the end of October 2017 in NHS England. Results About 307,307 patients were included, of which 63.8% presented directly to a non-specialist hospital (trauma unit (TU)). Fall from standing height in older patients, presenting and largely remaining in TUs, dominates the English trauma caseload. Contrary to perception, major trauma patients currently are being cared for in both specialist (major trauma centres (MTCs)) and non-specialist (TU) hospitals. Paediatric trauma accounts for <5% of trauma cases and is focussed on paediatric MTCs. Conclusions Within adult major trauma patients in England, mechanism of injury is dominated by low level falls, particularly in older people. These patients are predominately cared for in TUs. This work illustrates the reality of current care pathways for major trauma patients in England in the recently configured regional trauma networks.

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Patterns of moderate and severe injury in children after the introduction of major trauma networks

Archives of Disease in Childhood ◽

10.1136/archdischild-2018-315636 ◽

2018 ◽

Vol 104 (4) ◽

pp. 366-371 ◽

Cited By ~ 7

Author(s):

Samantha Jones ◽

Sarah Tyson ◽

Michael Young ◽

Matthew Gittins ◽

Naomi Davis

Keyword(s):

Major Trauma ◽

Injury Severity ◽

Research Network ◽

After School ◽

Trauma Network ◽

Body Parts ◽

Severe Injuries ◽

Traumatic Injuries ◽

Trauma Networks ◽

Outcomes For Children

ObjectiveTo describe the demographics, mechanisms, presentation, injury patterns and outcomes for children with traumatic injuries.SettingData collected from the UK’s Trauma and Audit Research Network.Design and patientsThe demographics, mechanisms of injury and outcomes were described for children with moderate and severe injuries admitted to the Major Trauma Network in England between 2012 and 2017.ResultsData regarding 9851 children were collected. Most (69%) were male. The median age was 6.4 (SD 5.2) years, but infants aged 0.1 year (36.5 days) were the most frequently injured of all ages (0–15 years); 447 (36.0%) of injuries in infants aged <1 year were from suspected child abuse. Most injuries occurred in the home, from falls <2 m, after school hours, at weekends and during the summer. The majority of injuries were of moderate severity (median Injury Severity Score 9.0, SD 8.7). The limbs and pelvis, followed by the head, were the most frequently and most severely injured body parts. Ninety-two per cent were discharged home and 72.8% made a ‘good recovery’ according to the Glasgow Outcome Scale. 3.1% of children died, their median age was 7.0 years (SD 5.8), but infants were the most commonly fatally injured group.ConclusionsA common age of injury and mortality was infants aged <1 year. Accident prevention strategies need to focus on the prevention of non-accidental injuries in infants. Trauma services need to be organised to accommodate peak presentation times, which are after school, weekends and the summer.

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Temporal variation in major trauma admissions

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2016.0040 ◽

2016 ◽

Vol 98 (2) ◽

pp. 128-137 ◽

Cited By ~ 8

Author(s):

WKM Kieffer ◽

DV Michalik ◽

K Gallagher ◽

I McFadyen ◽

J Bernard ◽

...

Keyword(s):

Seasonal Variation ◽

Major Trauma ◽

Injury Severity ◽

Resource Planning ◽

Research Network ◽

University Hospitals ◽

Significant Seasonal Variation ◽

Trauma Networks ◽

The Uk ◽

Time Of Admission

Introduction Trauma is a significant cause of morbidity and mortality in the UK. Since the inception of the trauma networks, little is known of the temporal pattern of trauma admissions. Methods Trauma Audit and Research Network data for 1 April 2011 to 31 March 2013 were collated from two large major trauma centres (MTCs) in the South East of England: Brighton and Sussex University Hospitals NHS Trust (BSUH) and St George's University Hospitals NHS Foundation Trust (SGU). The number of admissions and the injury severity score by time of admission, by weekdays versus weekend and by month/season were analysed. Results There were 1,223 admissions at BSUH and 1,241 at SGU. There was significant variation by time of admission; there were more admissions in the afternoons (BSUH p<0.001) and evenings (SGU p<0.001). There were proportionally more admissions at the weekends than on weekdays (BSUH p<0.001, SGU p=0.028). There was significant seasonal variation in admissions at BSUH (p<0.001) with more admissions in summer and autumn. No significant seasonal variation was observed at SGU (p=0.543). Conclusions The temporal patterns observed were different for each MTC with important implications for resource planning of trauma care. This study identified differing needs for different MTCs and resource planning should be individualised to the network.

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