Abstracts / Injury Extra 40 (2009) 139–146 141

Current management in paediatric splenic trauma

D. Robinson *, J. HamillStarship Children’s Hospital, Auckland, New Zealand

Aim: There has been a recent shift in the management of paediatricsplenic trauma, from surgical management to that of a moreconservative nature. This audit aimed to determine the current ratesof splenectomy in a paediatric population following a traumaticinjury.Methods: Retrospective review of all cases of splenic injurypresenting to Starship Children’s Hospital over the 31 monthsfrom 1 December 2005 to 30 June 2008.Results: Over the above-mentioned time period, there were a total of36 patients between the ages of 0 and 14 with a coded diagnosis ofSplenic Injury. Only one splenectomy was carried out at ourinstitution and all other cases of splenic injury secondary to traumawere managed conservatively, giving an overall rate of splenectomyof 2.8%. The median age at presentation was 8.5 years, the mostcommon mechanism of injury was sporting accidents, the medianhaemoglobin at admission was 123 g/l and the median lowesthaemoglobin during admission was 112. 8 g/l out of the 36 patientswere transfused with red blood cells. No patients received anultrasound scan only, 30 patients received a CT scan only and 6patients underwent both. The median length of stay in hospital was 5days.Conclusions: Splenic trauma in the paediatric population is arelatively common occurrence. This audit shows the trend towardsconservative management in recent years. Surgery can be safelyavoided in the majority of children suffering a splenic injury, andneed only be performed in multi-trauma patients with multiplesources of bleeding.

doi: 10.1016/j.injury.2009.03.025

Child restraint system use in vehicles in Victoria, Australia

C. Bevan a, C. Palmer b, V. Gorman b,*, C. Officer b

a Trauma Service, Emergency Department, Royal Childrens Hospital,

Melbourne, Australiab Trauma Service, Royal Childrens Hospital, Melbourne, Australia

Background: Motor vehicle collisions comprise a significantproportion of the injury burden in children. Extensive studieshave 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 andinconsistent, and there is evidence to suggest that parents remainuninformed regarding appropriate CRS.Objective: To review the use, and carers’ knowledge of CRS inchildren attending The Royal Children’s Hospital Melbourne.Method: A cross-sectional prospective survey was given to parentswhose children were visiting the outpatient or emergencydepartments.Results: 213 surveys including 299 children were completed. 82% ofchildren had been correctly restrained on the day of attendance, but13% had been placed in a CRS inappropriate to their weight. Withinspecific age groups, up to 24% of children had been placed in a CRSdesigned 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 Corporationbooklet on appropriate CRS use, comparison with the other surveyrespondents did not show a difference in CRS knowledge or practice.Conclusion: Although most children are appropriately restrained, asignificant proportion are not. A lack of parental knowledgeregarding CRS is evident. Based on these findings, we believe that acoordinated education campaign with improved guidance for

parents, and consistency and specificity in Australian CRSlegislation is a necessity.

doi: 10.1016/j.injury.2009.03.026

The role of CT in the head-injured child: A Royal Children’sHospital Melbourne perspective

V. Gorman *, C.S. PalmerTrauma Service, Royal Children’s Hospital Melbourne, Australia

Background: Head injury is a common presentation amongstchildren. The ability to use clinical predictors to identify childrenwith Intracranial Injury (ICI) has been evaluated by numerousresearchers. However, rates of CT use to detect ICI, both in practiceand algorithm prediction, vary widely.Objective: To review CT imaging rates in the head-injured popula-tion presenting to the Royal Children’s Hospital Melbourne (RCH)relative to actual and predicted rates generated by previous research.Methods: Patients presenting to RCH with a history of head traumabetween 2005 and 2007 were reviewed. Outcomes evaluatedincluded the presence of any pathology (ICI or skull fracture),admission or neurosurgical intervention. A subset of patients withmild presenting symptoms (GCS 14–15) was also analysed.Results: 4267 patients presented without prior CT; 741 (17%) hadCT scans performed. 3054 children were discharged from EDwithin 4hrs; 4% of these had a CT scan including 2 with diagnosedskull fracture. 1213 patients were subsequently admitted; 52% hadCT, of which 250 patients (40%) had pathology. Amongst 844admissions with GCS 14 or 15 on arrival, 453 (54%) had CT, ofwhom 34% had pathology. A total of 58 patients requiredneurosurgical intervention, and eight died. Three patients hadmissed pathology; none had adverse outcome.Conclusions: As a leading children’s hospital, great importanceshould be given to evidence based practice. Although RCH CTimaging rates appear higher than in published literature, currentpractice in the use of CT to detect head injury has a high sensitivityfor pathology detection.

doi: 10.1016/j.injury.2009.03.027

The true spectrum of handlebar injuries in children

C. Palmer a,*, S. Arul b, J. Crameri a,c

a Royal Children’s Hospital Melbourne, Australiab Department of Paediatric Surgery, Birmingham Children’s Hospital,

United Kingdomc Department of General Surgery, The Royal Children’s Hospital

Melbourne, Australia

Objective: The full spectrum and incidence of injuries caused byhandlebar impact in children has not been adequately described inthe literature. While bicycle handlebars are known to causesignificant intra-abdominal injury, there are a number of othervehicle types using handlebars which have not been fully exploredfor the incidence and severity of handlebar trauma.Method: prospectively identified trauma registry was searchedfor all trauma events relating to vehicles equipped withhandlebars from July 2000 through June 2008. Patients withinjuries involving handlebar impact were identified and studied ingreater detail.Results: Of 1565 traumas identified, there were 179 children witha 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 otherregions including the face (12%), thigh, perineum, neck and chest.Patient age and vehicle type were associated; in children ridingscooters, the most common site of handlebar impact was the face