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BackgroundInjury is a leading health burden in children yet relatively little is reported about the contemporary risks they face. Current national registry data may under-represent the true burden of injury to children. We aim to analyse contemporary patterns of paediatric trauma and identify current factors putting children at risk of injury.MethodsA 3-month prospective multicentre cohort evaluation of injured children across the London Major Trauma System was performed. All children receiving a trauma team activation; meeting National Institute for Health and Care Excellence CT head criteria; or admitted/transferred out due to trauma were included. Data were collected on demographics, mechanism and location of injury, and body region injured. The primary outcome was in-hospital mortality and secondary outcome was safeguarding concerns.Results659 children were included. Young children were more likely to be injured at home (0–5 years old: 70.8%, n=167 vs adolescents: 15.6%, n=31). Adolescents were more likely to be injured in the street (42.7%, n=85). Head trauma caused over half of injuries in 0–5 years old (51.9%, n=121). Falls were common and increasingly prevalent in younger children, causing 56.6% (n=372) of injuries. In adolescents, penetrating violence caused more than one in five injuries (21.9%, n=50). Most injured children survived (99.8%, n=658), however, one in four (26.1%, n=172) had safeguarding concerns and a quarter of adolescents had police, third sector or external agency involvement (23.2%, n=53).ConclusionsThis study describes modern-day paediatric trauma and highlights the variance in injury patterns in young children and adolescents. Importantly, it highlights differences in actual rates of injuries compared with those reported from current national registry data. We must understand real risks facing 21st century children to effectively safeguard future generations. The results provide an opportunity to reassess the current approach to injury prevention, child and adolescent safeguarding, and public health campaigns for child safety.

Objective We aim to compare conventional 3-port with single-incision laparoscopic surgery (SILS) for oophorectomy in patients undergoing ovarian cryopreservation. Background Demand for cryopreservation of ovarian tissue prior to the initiation of gonadotoxic treatment has risen significantly since its introduction in England in 2013. Traditionally, laparoscopic oophorectomy is performed using a 3-port technique with an umbilical port and 2 smaller 5-mm working ports. Energy devices can be used to allow haemostatic dissection of the ovary and this is delivered through the umbilical port site. In an attempt to improve efficiency, post-operative outcomes, and enhance cosmesis; our department initiated the use of the Applied Medical GelPoint Mini Advanced Access Platform single port technique using a vertical trans-umbilical approach for ovarian cryopreservation. Methods All patients undergoing laparoscopic oophorectomy for cryopreservation between September 2013 and August 2017 were included. The patients were consented for SILS, 3-port and open oophorectomies. All patients received maximum local anaesthetic wound infiltration intra-operatively. Case notes and theatre electronic data were reviewed and data was collected on additional procedure, conversion rate, operative time, post-operative analgesia requirement, complications and length of hospital stay. Results A total of 106 patients underwent laparoscopic oophorectomy during the study period. Of these, 40 underwent conventional 3-port, 65 had SILS and 1 patient had open. No cases were converted from the intended method. There was a statistically significant difference in the mean operative time; with SILS being faster than the conventional 3-port method (SILS: 40.4 min; 3-port: 51.7 min; p = 0.017). There was no difference in length of stay or perioperative analgesics, and complication rates in both groups were low. Informal qualitative feedback included surgeons stating that the ovary was much easier to deliver using the SILS technique. Patients were also happy with a single cosmetically appeasing scar hidden within the umbilicus. Conclusion SILS is an acceptable technique in ovarian cryopreservation allowing a quicker operative time, easier delivery of the ovary, and better cosmesis. A learning curve is recognised due to the ergonomics of single port laparoscopy; however, the technique can be established easily in departments with existing laparoscopic capabilities. This is the first paper which establishes this within a Paediatric Surgical setting, and adult literature suggests that further prospective trials may prove some benefit in ovarian tissue volume or time to initiation of treatment due to enhanced recovery.

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