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Aim: Penetrating head injuries (pHIs) are associated with high morbidity and mortality. Data on pHIs in children outside North America are limited. We describe the mechanism of injuries, neuroimaging findings, neurosurgery and mortality for pHIs in Australia and New Zealand.Methods: This was a planned secondary analysis of a prospective observational study of children <18 years who presented with a head injury of any severity at any of 10 predominantly paediatric Australian/New Zealand emergency departments (EDs) between 2011 and 2014. We reviewed all cases where clinicians had clinically suspected pHI as well as all cases of clinically important traumatic brain injuries (death, neurosurgery, intubation >24 h, admission >2 days and abnormal computed tomography).Results: Of 20 137 evaluable patients with a head injury, 21 (0.1%) were identified to have sustained a pHI. All injuries were of non-intentional nature, and there were no gunshot wounds. The mechanisms of injuries varied from falls, animal attack, motor vehicle crashes and impact with objects. Mean Glasgow Coma Scale on ED arrival was 10; 10 (48%) had a history of loss of consciousness, and 7 (33%) children were intubated pre-hospital or in the ED. Fourteen (67%) children underwent neurosurgery, two (10%) craniofacial surgery, and five (24%) were treated conservatively; four (19%) patients died.Conclusions: Paediatric pHIs are very rare in EDs in Australia and New Zealand but are associated with high morbidity and mortality. The absence of firearm-related injuries compared to North America is striking and may reflect Australian and New Zealand firearm regulations. [ABSTRACT FROM AUTHOR]

Burns are a cause of more than 5000 paediatric hospital admissions per year in England and Wales. Injury prevention and service provision may be better planned with knowledge of burn timing. Prospectively collected records from 1st January 2010 to 31st December 2011 were analysed. All episodes involving patients less than 16 years of age reviewed by the South West Children's Burns Centre were included. Data was collected from 1480 records to investigate seasonal, weekly, and daily variation. Day to day analysis showed significantly more burns occurred on Saturday and Sunday than Monday–Friday ( p < 0.001). Of all burns, 46% occurred within the time-period 08:00–15:59; however the mean hourly rate of burns was highest between 16:00 and 18:59. Of the larger burns (>10% body surface area), 38% occurred after 19:00. There was no statistically significant variation in the monthly ( p = 0.105) or seasonal ( p = 0.270) distribution of burns. Bank holidays did not cause a statistically significant increase in numbers. Injury prevention strategies are likely to have most volume impact by increasing awareness of the peak time for burns in children, enabling parents at home with young children to modify any risky behaviour and by targeting older children and their behaviour. [ABSTRACT FROM AUTHOR]

Aim: To examine Australian and New Zealand emergency department (ED) staff's training, knowledge and confidence regarding trauma-informed care for children after trauma, and barriers to implementation.Methods: ED staff's perspectives on trauma-informed care were assessed using a web-based self-report questionnaire. Participants included 468 ED staff (375 nursing and 111 medical staff) from hospitals in Australia and New Zealand. Data analyses included descriptive statistics, χ2 tests and multiple regressions.Results: Over 90% of respondents had not received training in trauma-informed care and almost all respondents (94%) wanted training in this area. While knowledge was associated with a respondent's previous training and profession, confidence was associated with the respondent's previous training, experience level and workplace. Dominant barriers to the implementation of trauma-informed care were lack of time and lack of training.Conclusions: There is a need and desire for training and education of Australian and New Zealand ED staff in trauma-informed care. This study demonstrates that experience alone is not sufficient for the development of knowledge of paediatric traumatic stress reactions and trauma-informed care practices. Existing education materials could be adapted for use in the ED and to accommodate the training preferences of Australian and New Zealand ED staff. [ABSTRACT FROM AUTHOR]