Biomedical subjects
Publications and source records attributed to T F Beattie.
Head injury is common in children, although the incidence of brain injury is much lower. Most children who sustain an injury to the head will only have a minor injury. Careful history, examination, and judicious use of radiology will identify those children at risk of brain injury. Children with no significant risk of brain injury may be safely discharged home to the care of responsible adults. Further work is needed to address sequelae after minor head injury.
Explore the source record for details and available documents.
If accidents cannot be prevented or ameliorated by protective devices, good first aid is essential to reduce the further effects of an injury. This paper highlights deficiencies in first aid knowledge among a random selection of the general population in Edinburgh. The results of this study indicate that first aid knowledge is generally deficient, with only 13% of people able to correctly treat all paediatric emergencies described. Recognised first aid courses, such as those run by voluntary agencies, focus their training on adult injuries, adapting care for children from this. There is no specific paediatric first aid course run by a recognised authority. Recommendations to improve this are made.
OBJECTIVE: To evaluate the possibility of setting up a database on childhood accidents within an accident and emergency (A&E) department. DESIGN: A proforma detailing epidemiological details about the child and details of the injury was designed and tested for accuracy. It was completed in parallel with the existing case documentation. A retrospective sample was analysed after completion of the study to determine times when data collection was poorest. SETTING: Regional paediatric hospital (total catchment population c. 500,000). RESULTS: Of 13,958 patients in whom full information was available, 65% had all the information available on the forms. Areas of discrepancy in the remainder included (1) transposition of date and time of injury with date and time of attendance (73%), (2) wrong coding (11%), (3) illegible digits (6%), (4) inaccurate data entry to computer (6%). Form completion was worst between 1800 hours and midnight. CONCLUSIONS: Data collection is feasible in the A&E department and is a necessary step in effective child accident prevention. It should be done using real time entry onto computer systems. Additional audit staff must be employed to ensure data collection is as complete as possible as close to the time of the initial attendance as possible. Regular analysis of the findings is essential.
OBJECTIVE: To determine the incidence and severity of injuries sustained by children who present to an accident and emergency (A&E) department following rollerblading accidents. DESIGN: A prospective case-control study. SETTING: The A&E department of a city centre paediatric teaching hospital. METHODS: Data were collected on a specially designed proforma on each child presenting with an injury sustained while rollerblading. The injury severity score was calculated for each patient and details were taken of the length of admission or outpatient follow up where appropriate. RESULTS: Seventy four children (37 male; 37 female) presented with injuries over a three month period. The age range was 6-13 years in both groups. Half the injuries occurred at weekends. Fractures (n = 37) and soft tissue injuries (n = 28) were the most prevalent; 89% of injuries involved the limbs. Sixty eight children (92%) required treatment in A&E. Four (3%) were admitted to hospital and required operative procedures under general anaesthetic. The injury severity score ranged from 1 to 9 with a mean of 2.8. The length of hospital stay for admissions was 1-3 days; 47 children required follow up in the outpatient department (1-3 visits). Average length of outpatient contact was 18 days. CONCLUSIONS: This study shows a greater incidence of rollerblading injuries than has been reported elsewhere. No figures are at present available for the United Kingdom as a whole.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Skiing on artificial ski slopes is enjoyed by a large number of children, but the rate and types of injuries amongst young skiers is unknown. During a 1 year prospective study the rate of injury was one per 394 h skied. One hundred and twelve children sustained 116 injuries, including 52 fractures. The ratio of upper to lower limb injuries was 4.5 to 1, with the thumb being the most commonly injured site. Although most injuries resulted from simple falls, five of the 12 patients with the most severe injuries (requiring admission), had injured themselves by crashing into the barrier at the bottom. It is concluded that the rate of injury to children on this artificial ski slope is unacceptably high. Measures are suggested to improve safety for children. These include: increasing supervision, carefully controlling numbers, enforcing the use of thumbless mittens with restrictions on the use of ski poles, increasing the 'run-off' area and improving padding on the barriers at the bottom. The different requirements of children from adults deserve consideration when introducing them to what were once 'adult' sports.
A computer model is described which uses blood volume deficit and its duration to simulate the first two hours of haemorrhage, including an estimation of the blood volume added by Starlings transcapillary refill mechanism. Computer prediction of the haematocrit was compared with published data on haemorrhage in animals. There was close correlation with data on the haemodilution caused by Starling's transcapillary refill mechanism in conscious swine (r = 0.84).
In a retrospective study, 110 patients episodes with intussusception presenting to a paediatric accident and emergency (A&E) department were reviewed, with particular attention being paid to presenting symptoms, time to diagnosis, radiological investigation, management and outcome. Between 1983 and 1993 100 patients presented to this department with 110 episodes of intussusception. Delay in diagnosis of greater than 12 h from initial medical contact was associated with increased morbidity. Associated factors in delayed diagnosis were departure from the classical symptoms (pain, vomiting and blood per rectum) and the presence of diarrhoea. General practitioner (GP) referral was to the medical team (rather than the surgical team) in around 50% of cases. Irrespective of the specialty of the first hospital doctor to see the patient only 42% were diagnosed correctly within 3 h of admission. In this population diarrhoea is a common symptom of intussusception and should alert the clinician rather than reassure. Because of its many presentations and relative rarity, intussusception remains a difficult condition to diagnose.
This paper documents deficiencies in ICD-9 coding which may influence the generation of statistics with regard to accident prevention. Problem areas are highlighted and remedial action suggested.
Monteggia fracture-dislocations are uncommon in childhood. Correct early diagnosis is essential to avoid elbow dysfunction and the necessity for open reduction of the radial head. This retrospective analysis of 220 forearm fractures in children shows that 50% of Monteggia fractures were misdiagnosed by accident and emergency (A&E) department senior house officers (SHOs) and 25% were misdiagnosed by senior radiologists. Instruction in correct clinical and radiological examination of the elbow joint in children to junior A&E doctors, with early review of suspicious cases by senior medical staff, may help to reduce the incidence of missed Monteggia fractures.
Four cases of transient cortical blindness following head injury in children are described. The theories regarding the pathophysiology of the condition are discussed and advice regarding management of such cases is given.
Interface pressures beneath six types of collar in volunteers were measured. Under certain types of collar mean interface pressures of more than 10 mmHg were obtained, with several individual readings around 30 mmHg. By causing jugular venous obstruction a similar rise in intracranial pressure may be produced inadvertently. The mechanisms of action for this are discussed. Those collars with the least tendency to produce jugular venous obstruction were of the moulded variety which extend support to the occiput, mandible and shoulder girdle. The authors therefore recommend this type of cervical splintage device where injury of the cervical spine is suspected. This paper emphasizes the potential danger to head-injured patients when the other devices are applied too tightly, producing a 'venous tourniquet' effect.
The existence of spinal cord injury without radiological abnormality (SCIWORA) has been recognized for some years. Two cases of SCIWORA in children are presented which highlight the possibility of severe spinal cord injury without any physical or radiological signs. The injury may occur at any level. It is recommended that normal procedures used for spinal immobilization in adults are inappropriate in the case of children and all unconscious children should be treated with full spinal immobilization until clinical assessment of neurological function is possible.
This paper assesses short stay ward facilities for children in the United Kingdom. The results of a postal questionnaire indicate that 50% of departments surveyed have a short-stay ward. Of these 25% admit small numbers of children. These are mainly children who have sustained trauma-related problems. The potential role of paediatric short-stay ward facilities is discussed.
A short-stay ward attached to the accident and emergency (A&E) department has opened recently. The development of this ward is described together with its operation over a 1-year period. Head injuries were the commonest reason for admission. Only 7% of children stayed longer than anticipated or were considered inappropriate admissions.