Spinal injuries in children are fortunately rare; however, it is important that they are assessed and managed in a timely manner. A systematic approach to traumatic spinal injuries should be used, by following recent evidence and national protocols, in order to avoid misinterpretation and potentially, inappropriate discharge. The aim of this article is to highlight the concepts of spinal imaging in paediatric trauma with regards to indications, interpretation and limitations.

Objectives To investigate the impact of the COVID-19 pandemic on our paediatric sickle cell service, including acute and elective activity, clinical performance and patient experience. Methods Data on acute and elective admissions during the 'COVID-19 pandemic year' (1 March 2020-28 February 2021) were extracted from our SCD database and Electronic Medical Records and compared with data from the preceding 2-year period. An online survey on patient experience during the pandemic was conducted during December 2020. Results During the COVID-19 pandemic year, we had 31 paediatric sickle cell inpatient admissions, which reflects a 47% reduction from the previous 2-year average (59). Hospital attendances decreased by 27%, and the mean length of stay (LOS) was shortened by 33% to 2.1±0.67 days. We also observed an improvement in our emergency management of vaso-occlusive episodes, with a 51% reduction in our mean 'door-to-analgesia' times (table 1). We had one COVID-positive case that did not require hospitalisation and no cases of delayed presentations. The number of outpatient clinic appointments was similar to the previous years, however the non-attendance rates reduced by 58%, possibly due to the selective provision of telephone consultations. Collaborating with our Specialist Haemoglobinopathy Team, we set up an outreach Transcranial Doppler (TCD) clinic locally, aiming to minimise patient travel, whilst ensuring adherence to the TCD monitoring standards (90% had a TCD within the recommended timeframes). Regular transfusions and hydroxycarbamide services continued uninterruptedly. In partnership with our community team, we organized live 'Parents and Young People's online forum' sessions on SCD and COVID-19, providing reassurance and guidance on accessing our services during the pandemic. We received 38 responses to our online patient survey, representing 27% of our cohort. Over 85% of respondents felt supported during the shielding period. Interventions rated positively by the majority were the outreach TCD clinic, the continuation of the dedicated phlebotomy service and the online forum sessions. Conclusions Our results show that during the COVID-19 pandemic we have maintained safe and uninterrupted paediatric sickle cell services and improved our clinical performance in delivering timely emergency analgesia for acute painful sickle cell episodes. The reductions in hospital attendances, admissions and LOS are likely to have a multifactorial aetiology related to the pandemic and the associated lockdowns, including reduction of exposure to sickle crisis triggers and reluctance to attend hospital. Interventions such as

Children with sickle cell disease can develop life-threatening and painful crises that require prompt assessment and efficient management by healthcare professionals in the emergency or acute care setting. Due to migration patterns and improved survival rates in high-prevalence countries, there is an increased tendency to encounter these patients across the UK. These factors warrant regular revisions in sickle cell crisis management, along with education for medical personnel and patients to improve clinical care and patient management. The focus of this article is on the initial assessment and management of acute paediatric sickle cell complications in the emergency setting. Specific case studies, including acute pain crises, trauma, splenic sequestration, aplastic crises, acute chest syndrome, infection, avascular necrosis, osteomyelitis and stroke, are discussed. Due to the current COVID-19 pandemic, we have also reviewed specific concerns around this patient group.

Major incidents are rare but require a large amount of preparation, co-ordination and communication across different emergency services and specialities. This ensures that casualties are efficiently managed within the constraints of limited clinical resources. This article aims to provide a brief understanding of what constitutes as a major incident, how it is declared and the chain of command in communication and action, focusing specifically on the paediatric process. It also aims to highlight important considerations that could potentially be missed (eg, the mental health impact, forensic evidence and so on).

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