Objectives While cervical spine injuries (CSIs) are rare in the paediatric population, presentations to EDs with possible neck injuries are common. Based on a lack of Australian data we set out to determine how many possible injuries are clinically cleared, what imaging is used on the remainder and the incidence and characteristics of confirmed paediatric CSIs. Methods We undertook a retrospective electronic medical record review of children <18 years with potential CSIs at a large tertiary paediatric trauma centre in Victoria, Australia over a 12 month period (annual census 87 000). For possible injuries we extracted key epidemiologic, imaging and short‐term outcome data. Results During the study period, a total of 617 patients with potential neck injuries were seen in the ED (617/87 000, 0.7%). The median age was 11 years. The most common mechanisms of injury were falls (41%), motor vehicle injuries (28%) and sports‐related injuries (24%). Four hundred and fourteen of 617 (67%) underwent neck imaging (345/414, 83% plain radiograph; 100/414, 24% computed tomography; 7/414, 1.6% magnetic resonance imaging). Twenty‐three of 617 (4.1%) had radiologically documented CSIs. Two required operative interventions for their neck injuries. Conclusion While two‐thirds of children with potential CSIs undergo radiological evaluation, actual injuries are rare (<4%). These data suggest that there is a potential for improved targeting of cervical spine imaging for trauma. The development of a clinical decision tool may help reduce neck radiography.

To fulfil both risk management and CNST, we audit all haemorrhage >2000ml identified through EuroKing, against our departmental guideline, in a monthly multidisciplinary risk meeting (including laboratory staff). A modified data collection tool from SCASMM is used. Comparison is made with the most recent (2009) annual Scottish audit of haemorrhage >2500ml. Conclusions Data is broadly comparable with a recognised national audit. Our process provides a robust method for continuous audit of haemorrhage. Introduction of a proforma (Nov 2010), presentation at departmental meetings (6 month intervals) and improved awareness/accountability has achieved improvements including: Increased obstetric consultant presence; Improved documentation; Reduced blood in major haemorrhage pack from 6 to 4 units (>4 units only used in 9.7%). Abstract PL.31 Table Southmead Nov –Oct 11 SCASMM (2009) Number >2000ml 62 N/A >2500ml 28 (4.61 per 1000) 306 (5.18 per 1000) Most frequent causes (60 notes fully reviewed) Atony (33) 55% 54.5% Retained placenta (13) 21.7% 19.4% Vaginal laceration (11) 18.3% 20.1% Most frequent mode of delivery SVD (20) 33% 30% Emergency caesarean (19) 31.6% 41.4% Elective caesarean (8) 13.3% 9.8% Haemostatic surgical techniques Intrauterine balloon (6) 10% 19% B-Lynch suture (5) 8.3% 9% Ut. artery embolisation (1) 2% 3% Hysterectomy (1) 2% 8% Nov10-Apr11 May11–Nov11 Consultant obstetrician present >2000ml 72% 84% N/A >2500ml 93% 100% 73% Proforma used 65% 80%