6608 Top to toe – comparing the assessment of paediatric head injuries between paediatric and emergency physicians

Objectives Over 1 million people attend emergency departments in England and Wales with a head injury annually, with up to 50% of these patients under the age of 15.1 Although most have minor injuries, head injuries can signify underlying safeguarding concerns. RCPCH 2018 guidance described paediatric emergency departments (PEDs) as a potential first point of contact for children who have been subjected to abuse or neglect and the active role clinicians must play in the early recognition of these individuals.2 This study aims to review the assessment of paediatric head injuries, and consideration of safeguarding concerns, in a PED in a large district general hospital, comparing the differences between paediatricians and emergency physicians. Methods Retrospective cross-sectional study at a single PED (01/01/22 – 31/12/22). Infants up to two years of age attending with a head injury were included. All PED attendances coded as 'head injury' were selected for screening. Data was collected on attendance details, examination findings, consideration of non-accidental injury and whether verbal and written discharge advice was given, as per NICE head injury recommendations.3 Data was extracted from medical electronic and paper records and analysed using Microsoft Excel. A chi-square test was used to determine significance. Results 383 patients were identified as having attended the department with a head injury, with 345 patients having accessible documentation (e.g., did not self-discharge or were streamed to primary care). Paediatricians were significantly more likely than emergency physicians to perform a head-to-toe examination of the child (83% vs 51%; pConclusion It is perhaps unsurprising that more time-intensive assessments of safeguarding concerns in children with head injury (head-to-toe, exposure of skin) are less commonly utilised in clinical practice in busy PEDs. This data suggests further education is needed for emergency physicians for consideration of safeguarding concerns when approaching an infant with a head injury. Despite being significantly more likely to perform these assessments, this should also be considered for paediatricians given that 17% did not perform a head-to-toe examination. References 'Context – head injury: assessment and early management: guidance.' NICE, 18 May 2023, nice.org.uk/guidance/ng232/chapter/Context 'Facing the future: standards for children in emergency care settings.' RCPCH, June 2018, rcpch.ac.uk/sites/default/files/2018- 06/FTFEC%20Digital%20updated%20final.pdf 'Recommendations – head injury: assessment and early management: guidance.' NICE, 18 May 2023, https://www.nice.org.uk/guidance/ng232/chapter/Recommendations