Child restraint system use in vehicles in Victoria, Australia

Abstract

Aim: There has been a recent shift in the management of paediatric splenic trauma, from surgical management to that of a more conservative nature. This audit aimed to determine 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 time period, there were 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 were managed 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 patients underwent both. The median length of stay in hospital was 5 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.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 children were 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 did not show a difference 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 b...