We demonstrate a good correlation between weight and MSCD in a large group of children. Use of the simple formula MSCD (mm)=0.4 W+20 could improve the success rates of lumbar puncture in the paediatric population, but remains to be validated.

The identification of an abdominal mass in a child, either coincidental or symptomatic, may be due to a tumour. An abdominal tumour may present with life-threatening symptoms, requiring prompt assessment and management. Although the discovery of such a finding usually warrants inpatient transfer or outpatient referral to the tertiary oncology centre, the initial evaluation, management and communication with the family by the general paediatrician is crucial. A thorough history and examination, which includes an organised, structured approach to abdominal masses, is paramount. The anatomical location of the mass, age of the patient and the presence of any associated symptoms or signs must be considered together in order to formulate a list of potential differential diagnoses and guide the next appropriate investigations. This article aims to guide general paediatricians through the assessment and initial management of a child presenting with an abdominal mass suspected to be a tumour.

AimsOver the last seven years we have undertaken an annual audit of our management of bronchiolitis. Over this time, several interventions have been introduced as part of a clinical improvement programme. Following the introduction of a ‘paperless’ hospital in October 2014, we have re-audited this year, to see whether the loss of paper-based guidelines had altered practice.MethodsHospital admissions of infants <1 year old over the period 1/10/2014–31/03/2015, with a clinical diagnosis of bronchiolitis, were included. Notes were individually reviewed using the hospital computer system. Targets for investigations and managements were set, in accordance with previous years: nasopharyngeal aspirate (NPA) at <5%; chest x-ray at 10%; blood cultures at 10% and bloods at 10%. NPAs are no longer used routinely as data from previous years has indicated that it does not change our management. Data was also collected on steroid, antibiotic, salbutamol, ipratropium, saline nebulisers and IV fluids. PICU/HDU admissions were excluded from this cohort, but were reviewed separately. All results were compared to previous years’ audit results.Results65 patients met our inclusion criteria. There was an overall increase in each investigation compared to last year (Figure 1). There was an increase in steroid and salbutamol treatment. Steroid treatment increased to 9% (Figure 2) and salbutamol treatment increased to 25% (Figure 3). There was also an increase in PICU/HDU admissions to 19 (previous year: 8). 11 of these were admitted to PICU/HDU for treatment with optiflow.Abstract G346(P) Figure 1Percentage of admissions investigated with NPAs, blood cultures, bloods or chest X-ray (CXR) over seven yearsAbstract G346(P) Figure 2Percentage of admissions treated with antibiotics or steroids over seven yearsAbstract G346(P) Figure 3Percentage of admissions treated with salbutamol, ipratropium, saline nebulisers or IV fluids over three yearsConclusionAlthough not statistically significant, the increase in inappropriate management of bronchiolitis this year suggests the need to ensure protocols previously implemented via integrated care pathways are still being followed adequately when changing to an electronic system. This may apply to other management protocols. It has been decided to produce monthly progress posters to remind staff of appropriate management, in addition to embedding the original integrated care pathway into the electronic record system.

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Aims Samples of cerebrospinal fluid (CSF) are required for the management of many disease states. One of the commonest errors in performing lumbar punctures (LPs) is inaccurate insertion of the spinal needle (too shallow or too deep), with blood contamination often complicating subsequent laboratory interpretation. We previously demonstrated a good correlation between ultrasound measures of spinal canal depth (SCD) and body weight in neonates, producing a nomogram (1) which has been tested in clinical practice (2). Here, we present preliminary data from ultrasound and auxological assessment in an older general paediatric population. Other studies have been limited by small cohort size, measurements being taken in the supine position during CT, or data gathered post-LP procedure, based on recall of depth of needle insertion. Methods Single-centre study of patients aged 0–18 years presenting at a tertiary paediatric centre. Patients were recruited from cardiology outpatients, PICU and paediatric inpatient wards. Individuals with pre-existing spinal abnormalities were excluded. Ultrasound measures of the spinal canal were performed in the left lateral position to obtain anterior and posterior SCDs; from these measures the mid-SCD (MSCD) was calculated. Patient age and auxological parameters including patient weight, height and body surface area (BSA) were recorded. Results 125 children were recruited and had complete data recorded (figure 1). The median age of the study population was 7.0 years (range 0.3-16.0). All auxological data are presented as means (standard deviation; range). Weight was 30.6 kgs (16.1; 7.8-88.9) and height 128 cms (29.1; 67.9-179.6), resulting in a mean BSA of 1.03 m2 (0.39; 0.35-1.88). We identified a linear correlation between MSCD (mm) and age (R2 0.68), weight (R2 0.79), height (R2 0.74) and BSA (R2 0.79). The approximated formula for predicting MSCD from body weight (W Kg) in this cohort is MSCD (mm) = 0.4W + 20 (figure 1). Abstract G199 Figure 1 Correlation of mid-spinal canal depth to auxological factors Conclusion Our preliminary data demonstrates good correlation between both patient weight and BSA and MSCD in an unselected older general paediatric population. The most practical MSCD correlation is likely to be that based on weight, as height is infrequently routinely measured in clinical practice. This needs testing in clinical practice.