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guidance states that before carrying out a CPME you must be satisfied that it is necessary and appropriate. You must be clear about what will be achieved and whether or not the outcome is likely to affect the proposed course of action.We therefore call for clarity between all agencies with regard to the threshold required for a CPME to occur following referrals received for physical abuse allegations.We recommend that in preschool and younger children with limited verbal skills social workers should refer for a CPME to be undertaken where there is an allegation of physical abuse regardless of whether an injury is seen. In verbal children a CPME should be done when there is a significant allegation even if no injury is seen to ensure there are no hidden injuries.

Centres have upheld this standard differently, including allowing 16-17 year-olds to choose their preferred care location.We work in a central London teaching hospital and major trauma centre; due to the pressures on the Emergency Department (ED) during the pandemic, 16-17 year-olds were switched from being cared for in the AED to the PED. We studied the impact on patient care to ascertain whether this is a model to which we should move permanently.

Aims Triage is a key principle in the effective management of major incidents. However, there is an increasing body of evidence demonstrating that existing paediatric methods are associated with high rates of under-triage and are not fit for purpose. The aim of this study was to derive a novel paediatric triage tool using machine learning (ML) techniques. Methods The United Kingdom Trauma Audit Research Network (TARN) database was interrogated for all paediatric patients aged under 16 years for the ten-year period 2008-2017. Patients were categorised as Priority One if they received one or more life-saving interventions from a previously defined list.Six ML algorithms were investigated for identifying patients as Priority One. Subsequently, the best performing model was chosen for further development using a risk score approach and clinically relevant modifications in order to derive a novel triage tool (LASSO M2).Using patients with complete pre-hospital physiological data, a comparative analysis was performed with existing prehospital paediatric major incident triage tools. Subsequent external validation was performed using the UK military Joint Theatre Trauma Registry (JTTR). Performance was evaluated using sensitivity, specificity, under-triage (1-sensitivity) and over-triage (1-positive predictive value). Results Complete physiological data were available for 4962 patients. The LASSO M2 model demonstrated the best performance at identifying paediatric patients in need of life-saving intervention, sensitivity 88.8% (95% CI 85.5, 91.5) and was associated with the lowest rate of under-triage, 11.2% (8.5, 14.5). In contrast, the Paediatric Triage Tape and Jump-START both had poor sensitivity when identifying those requiring life-saving intervention (36.1% (31.8, 40.7) and 44.7% (40.2, 49.4)) respectively. Performance was unchanged in the external validation dataset. Conclusion The ML derived triage tool (LASSO M2) outperforms existing methods of paediatric major incident triage at identifying patients in need of life-saving intervention in both the internal and external validation datasets. Prior to its recommendation for clinical use, further work is required to conduct a feasibility assessment and user acceptability trial in clinical conditions.

Aims/Objectives/BackgroundThis study aims to evaluate changes to child safeguarding attendances to the emergency department (ED) during the lockdown period 1st of March till 31st May 2020 compared to the same time period in 2019.The COVID-19 pandemic is the defining health crisis of our time and the first time firm social restrictions have been imposed since safeguarding practices have become embedded in the NHS. The NSPCC reported a large increase in contacts but there remain concerns that vulnerable children are invisible to agencies during this time.Methods/DesignAll children (< 18 years) who attended King’s College Hospital’s ED, and were reviewed in the weekly ED safeguarding meeting were included. Data was collected from electronic patient records for different parameters.Results/ConclusionsThe total number of children presenting via ED for safeguarding review fell from 865 in 2019 to 355 for the same period in 2020. However, the proportion requiring action by the hospital safeguarding team showed a significant increase (p= 1.5 x 10-4) suggesting the severity of cases during COVID-19 is worse.The percentage of stabbings doubled (p=0.04) despite lockdown measures. This may be a contributor to the significant increase in referral to youth workers (p=8 × 10-4). The number of children attending who were considered high risk due to previous safeguarding concerns dropped by 75%.As expected, the proportion of household injuries such as accidental ingestion and burns showed a significant increase (p=0.01 and p=0.002 respectively). The proportion of children from outside of our local boroughs was surprisingly higher in 2020 (p=0.03).The findings show that the number of cases triggering a safeguarding review has dropped during lockdown and raises concerns about vulnerable children who remain hidden. The findings also suggest an increased severity of safeguarding presentations, supporting our fears that the implications of lockdown on vulnerable children is yet to be realised.