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• Thoracic trauma is an important cause of morbidity and mortality in children exposed to blast and early recognition of these injuries is vital. • No studies have investigated the sensitivity of chest X-ray (CXR) for the detection of chest injury in paediatric blast casualties. • CXR findings were compared to the 'gold standard' of CT for detection of significant thoracic injuries in 103 children who were injured by blast. • CXR has low sensitivity for detecting thoracic injury in children exposed to blast, necessitating a low threshold for the use of CT for such patients. Thoracic trauma is an important cause of morbidity and mortality in children exposed to blast and early recognition of these injuries is vital. While numerous studies have investigated the sensitivity of chest X-ray (CXR) for the detection of chest injury in blunt trauma, none have evaluated its performance in paediatric blast injury. CXR and Computed Tomography (CT) thorax findings were compared for 105 children who were injured by blast and presented to the UK Role 3 Hospital, Camp Bastion, Helmand Province, during the recent conflict in Afghanistan from 2011 to 2013. CXR performance was evaluated compared to the 'gold standard' of CT for the detection of significant thoracic injuries, defined as pneumothorax, haemothorax, aortic or great vessel injury, 2 or more rib fractures, ruptured diaphragm, sternal fracture, penetrating fragments and pulmonary contusion or laceration. The sensitivity of CXR for the detection of significant injuries was: pneumothorax 43%, haemothorax 40%, contusion 44%, laceration 100%, blast lung 80% and subdermal metallic fragments 75%. CXR missed all cases of diaphragm injury, ≥2 rib fractures, clavicle fracture and pleural effusion, although numbers of each were small. Specificity for CXR injury detection was 94% for contusion and 93% for fragment, and 100% otherwise. The sensitivity and specificity of CXR for identifying an abnormality that would prompt CT imaging was 72% (95% CI 55–85%) and 82% (95% CI 70–90%). CXR has a poor sensitivity for the identification of significant thoracic injury in children exposed to blast. We argue that, given the challenge of clinical assessment of injured children and the potential for serious adverse consequences of missed thoracic injuries, there should be a low threshold for the use of CT chest in the evaluation of children exposed to blast. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to investigate the planned place of delivery for women antenatally diagnosed with abnormally invasive placenta (AIP) in England and identify how many units regard themselves to be "specialist centers" for the management of AIP.Material and Methods: Observational study of obstetric-led units in England. An anonymous survey was sent to the delivery suite lead clinician in all 154 consultant-led units throughout England. The main outcome measures were whether each unit planned to manage AIP "in-house", the estimated number of AIP cases delivered in the previous 5 years and whether the unit considered itself a "specialist center" for AIP management.Results: In all, 114 of 154 units responded (74%): 80 (70%) manage AIP cases "in-house", 23 (29%) of these report that they regard themselves "specialist centers" for AIP. The 23 "specialist centers" managed significantly more cases than "non-specialist centers" (5.4, 95% confidence interval (CI) 4.3-7.3 vs 2.3, 95% CI 1.5-3.1 cases/unit/year; P < .001); nearly one-third of "non-specialist centers" manage less than 1 case per year. Extrapolating the reported number of cases to all 154 obstetrician-led delivery units produces an estimate of 5.2 cases per 10 000 births over the last 5 years.Conclusions: Most units plan to manage AIP "in-house" despite encountering few cases each year. Centralizing care would allow the multidisciplinary team in each "specialist center" to develop significant experience in the management of this rare condition, leading to improved outcomes for the women. [ABSTRACT FROM AUTHOR]