ObjectiveWe aimed to compare adolescent mortality rates between different types of major trauma centre (MTC or level 1; adult, children’s and mixed).MethodsData were obtained from TARN (Trauma Audit Research Network) from English sites over a 6-year period (2012–2018), with adolescence defined as 10–24.99 years. Results are presented using descriptive statistics. Patient characteristics were compared using the Kruskal-Wallis test with Dunn’s post-hoc analysis for pairwise comparison and χ2 test for categorical variables.Results21 033 cases met inclusion criteria. Trauma-related 30-day crude mortality rates by MTC type were 2.5% (children’s), 4.4% (mixed) and 4.9% (adult). Logistic regression accounting for injury severity, mechanism of injury, physiological parameters and ‘hospital ID’, resulted in adjusted odds of mortality of 2.41 (95% CI 1.31 to 4.43; p=0.005) and 1.85 (95% CI 1.03 to 3.35; p=0.041) in adult and mixed MTCs, respectively when compared with children’s MTCs. In three subgroup analyses the same trend was noted. In adolescents aged 14–17.99 years old, those managed in a children’s MTC had the lowest mortality rate at 2.5%, compared with 4.9% in adult MTCs and 4.4% in mixed MTCs (no statistical difference between children’s and mixed). In cases of major trauma (Injury Severity Score >15) the adjusted odds of mortality were also greater in the mixed and adult MTC groups when compared with the children’s MTC. Median length of stay (LoS) and intensive care unit LoS were comparable for all MTC types. Patients managed in children’s MTCs were less likely to have a CT scan (46.2% vs 62.8% mixed vs 64% adult).ConclusionsChildren’s MTC have lower crude and adjusted 30-day mortality rates for adolescent trauma. Further research is required in this field to identify the factors that may have influenced these findings.

This audit demonstrated a significant improvement in compliance following implementation of our educational bundle. This has enabled improvement in standardised and evidence-based patient care across Wales.

We were interested in the paper by Srinivasan et al 1 as it brings into focus the differences in the epidemiology of firearm injuries in children and young people between the USA and the UK and the importance that gun control has had in child and adolescent safety here. Through the Child Death Review in Wales, we have previously reviewed deaths from firearm injuries in the UK. This followed the death in Wales of a young person by his own hand using a shotgun. This prompted us to examine the problem of firearm deaths to children and young persons in Great Britain. 2 We hoped to search for common themes that underpin the causes of childhood firearm deaths and investigate the scope for prevention.In the paper from America, 1 the incidence of fatal firearm injuries attending emergency rooms was 0.4/100 000 (CI −02 to 1.0) with a non-fatal rate of 23.5 (CI 14.1 to 32.9). The fatal rate quoted is for children presenting dead or dying to emergency departments, and the overall rate of firearm injuries deaths is much larger (3.2/100 000 children 3 ) in 2010. Of the injuries in emergency room study, 64% were unintentional. Some of these unintentional shootings may occur when children are unsupervised in a home, find a loaded gun and accidentally fire it. There are also youth suicides.In our study between 2005 and 2010, 41 children were killed by firearms: 1 in Scotland, 4 in Wales and 36 in England. Looking at England and Wales, the incidence in children 0-18 years is 0.057/ 100 000/year. The age range was 18 months to 17 years, with a majority (32) aged 15-17 years. There were 8 accidental deaths, 6 suicides and 27 murders. Eight deaths involved air rifles. Notably of the murders, 24 children were of Afro-Caribbean origin and 4 were female. There was a geographical variation, with 16 murders occurring in London and 6 in Manchester. Nineteen cases of murder were linked to criminal gangs.

Introduction Up to 10% of infants require assistance at birth. Paediatricians, midwives, obstetricians and anaesthetists could all potentially be involved, and each Royal College recommends some form of newborn life support training. This study aimed to determine training and confidence levels amongst staff present at infant deliveries. Method Midwives, ANNPs and all grades of doctors in Paediatrics, Obstetrics and Anaesthetics across Wales were surveyed with an anonymous online questionnaire to assess level of experience, training and confidence ratings in performing newborn resuscitation. Results 180 questionnaires were completed (response rate 32%). The majority had been involved in newborn resuscitations (Table 1). 35% Obstetricians, 53% Anaesthetists, 57% Midwives, 55% Paediatricians received no form of training prior to attending deliveries, (Table 2) shows overall levels of training. 43% had completed NLS in the last 4 years. Confidence levels varied between specialities (Graph 3), with a statistically significant increase in those completing an NLS course. Overall 94% of those completing NLS felt it assisted them at deliveries, with 97% rating themselves as confident in their resuscitation skills. Discussion This study demonstrates that all the health professionals questioned are involved in newborn resuscitation and therefore should have resuscitation training. There is wide variation in levels of training and confidence, with recommendations of the Royal colleges not currently being met, even by some attending paediatric doctors. Our study has shown that Foundation and General practice trainees in particular, are less experienced, less likely to have life support training, and are less confident in their ability to resuscitate infants at birth. With units across the UK seeing an increasing proportion of non-career Paediatricians working on their rota’s, this is an important finding. Appropriate training in resuscitation, such as NLS, is vital for any health professional who may be in attendance at newborn deliveries. This should be undertaken prior to commencing jobs that require this role, and skills should be refreshed at regular intervals. Where formal training is given, a demonstrable improvement in confidence is seen across the multi-professional team, and is likely to improve patient safety. Abstract G111(P) Table 1 Recsuscitation experience (%) Abstract G111(P) Table 2 Recsuscitation training experience (%) Abstract G111(P) Figure 1 Graph 1: Confidence levels.

Aim Bronchiolitis has a significant burden on child health and previous studies have shown considerable variation of management. We aimed to audit current national practice of bronchiolitis management against both local trust guidelines and the 2006 SIGN guidelines. Methods A prospective observational study of infants diagnosed with bronchiolitis took place between 1st November and 31st December 2012 throughout all 13 acute paediatric centres in Wales. An audit proforma was designed using the SIGN guidelines as the gold standard. The local trust guidelines were also used for comparison. Recognised missing case notes were audited retrospectively. Microsoft Excel was utilised for data processing. Results Data was collected for 752 children (56% male), aged 2 weeks to 12 months. Poor feeding was the most common presenting symptom. Investigations undertaken were variable: 0–69% of children had blood tests (FBC, U&E, CRP, blood culture); 6–36% chest radiographs and 0–76% nasopharyngeal aspirates. Of those children that had chest radiographs, 0–50% had a fever and 0–100% had antibiotics. 0–47% of children received NG feeding and 0–27% had IV fluids; 0–57% received oxygen. Medication used included salbutamol, atrovent, hypertonic saline, saline drops and antibiotics. Criteria for feeding and oxygen saturations on discharge were universally similar (>75% and >94% respectively). Overall compliance across Wales, for investigations, treatment and discharge was 39%. This table details individual hospital compliance with the SIGN guidelines, which was the same as local guidelines: Hospital Overall Compliance (%) 95% Confidence Interval A 56 32–80 B 50 44–56 C 57 44–70 D 26 16–36 E 12 8–40 F 11 0–23 G 63 57–81 H 21 16–26 I 13 6–19 J 25 19–30 K 17 0–35 L 73 51–95 M 33 24–44 Conclusion This audit demonstrates the wide variability of management of bronchiolitis within Wales and the suboptimal compliance with both local and SIGN guidelines. Currently an education bundle is being disseminated across all centres, highlighting key areas for improvement. The audit loop will be completed during the forthcoming season, aiming to demonstrate an improvement in compliance and a reduction in management variability following our educational intervention.