G49 Skeletal surveys in patients <2 yo presenting with fractures to the ed department: when are they appropriate?. (27th April 2015)

• Record Type: Journal Article
• Authors: McGlacken-Byrne, SM; Okafor, I; Deiratany, S; McNamara, R
• Is Part Of: Archives of disease in childhood. Volume 100(2015)Supplement 3
• Page Start: A20
• Page End: A20
• Publication Date: 2015-04-27
• Subjects: Children -- Diseases -- Periodicals; Infants -- Diseases -- Periodicals; 618.920005
• DOI: 10.1136/archdischild-2015-308599.48
• Languages: English
• ISSNs: 0003-9888

Abstract

Abstract : Aims: To audit current practice and develop guidelines on the ordering of skeletal surveys in patients &lt;2 yo presenting with fractures to our ED department Methods: We used the guideline published in Paediatrics: &quot;Development of Guidelines for Skeletal Survey in Young Children with Fractures&quot;. 1 Using our online server we reviewed data over two years (2012–2013). Patients &lt;24 months and any patient presenting with a fracture presenting to ED were included. In accordance with the guideline, data audited included age (0–11 ms, 12–23 ms), developmental status (ambulatory v non-ambulatory), time from fracture to presentation, history and mechanism of injury, pertinent features on examination, existent co-morbidities, radiological characteristics and age of fracture, decision to skeletal survey and time from fracture to skeletal survey. Results: 59 patients were identified over the two year period (range 22 days–23 months). 20.3% (n = 12) were between 0–11 ms, 79.7% (n = 47) were between 12–23 ms. 1 patient (1.7%) aged 9 ms had a skeletal survey. If the above guideline had been applied, 40.7% of this patient cohort would have warranted a skeletal survey, and 75% (n = 9) of our 0–11 agegroup and 31.9% (n = 15) of our 12–23 agegroup would have qualified for a skeletal survey. Conclusion: In a busy ED department with short physician-patient interaction a systematic approach to child protection is of paramount importance. This data suggests that our centre is under-utilising skeletal surveys in the management of children under the age of 2 presenting with fractures to our ED department. Significant cultural differences may impact on the relevance of this guideline for our patient population. We are developing a new protocol to help ED doctors decide when a skeletal survey is appropriate in vulnerable children. Reference: Wood JN, Fakeye O, Feudtner C, et al . Development of guidelines for skeletal survey in young children with fractures. Pediatrics . Originally published online June 16 2014, DOI: 10: 10.1542/peds.2013-3242.