dr e payne, dr h murch & dr c woolley ysbyty ystrad fawr hospital, aneurin bevan university...
TRANSCRIPT
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Dr E Payne, Dr H Murch & Dr C Woolley
Ysbyty Ystrad Fawr Hospital,
Aneurin Bevan University Health Board
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Concerning features (RCPCH Child Protection Companion 2008) Age Doesn’t fit the injury Doesn’t fit with development Inconsistent history Unwitnessed Inappropriate parental response Repeated attendance Known to social services
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Types of fracture suspicious of abuse
(RCPCH Child Protection Companion 2008) Multiple fractures Humeral Rib fractures Femoral fractures (non-mobile child) Spinal fractures Metaphyseal fractures Skull fracture.
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Audit aims
To study fractures seen in children under 3yrs in A&E during 2012-13.
To evaluate the documentation & assessment as recommended by RCPCH Child Protection Companion 2008.
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Method
Retrospective analysis of medical records for children under 3 years with fracture presenting to A&E in two Gwent hospitals.
N = 106
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Age distribution
N=106 F 54, M 52.
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Site of fracture
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Risk factors for NAI
No mechanism of injury 8.5%
Delay in presentation 23%
Unwitnessed injury 3.5%
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Action
6/32 discussed when 1 risk factor
2/9 discussed when 2 risk factors
0/1 discussed when 3 risk factors
1/2 discussed when 4 risk factors
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Conclusions Adherence to departmental guidelines in
2/3 cases.
Lack of recognition of risk factors for NAI.
Very few referrals to paediatrics & social services.
Opportunities for discussions about NAI are missed.
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Intervention Mandatory training in Child Protection (e-
LFH) for A&E juniors.
A&E triggers:
A&E database to include red flags for NAI.
Paediatric nurse triaging to discuss with A&E senior.
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