Trials and Tribulations: Ross Fisher on Paediatric Trauma at the London Trauma Conference

You’ve probably worked out by now that the London Trauma conference was full of awesomeness and controversy. Obviously I’m biased, but I found the paediatric stream particularly engaging and I was lucky enough to be able to grab some post-talk discussion time with Ross Fisher, friend of St Emlyns and Consultant Paediatric Surgeon at Sheffield Children’s Hospital. Ross talked about both paediatric trauma research and about rethinking our approach to paediatric trauma.

Trials

Paediatric trauma scares people – it’s actually pretty rare in the UK and the most recently published data from the TARN database suggests that the majority of paediatric trauma is still seen not at specialist paediatric trauma centres but at district general hospitals. So it stands to reason that even if we don’t expect to see paediatric major trauma – we have to expect to see paediatric major trauma. This will probably always be the case to a certain degree – it’s likely there’ll always be a cohort of walk-in trauma patients due to the fact that many children are easy to scoop onto the back seat of a car and carry in through the ED’s front door.

One of the challenges Ross identifies is the huge gap in paediatric trauma research and he challenges us to get involved – his advice was to start with a small audit project and contribute to a knowledge base which is distinctly lacking. If you or your department would like to get involved in paediatric trauma research then the PERUKI network is a great way to do so.

Tribulations

In his talks Ross called on us to recognise differences in paediatric trauma – of course you can start with your adult skills but there are important differences you need to be aware of; simply downsizing by proportion and applying adult trauma principles doesn’t quite work. We have to appreciate that there are significant differences in anatomy, physiology and paediatric trauma management.

Ross also reiterated his standpoint on FAST scanning in paediatric patients; he points out that firstly there is a lack of evidence for reliability of FAST in kids and secondly the decisions we make in light of our FAST findings are also different, a viewpoint reiterated in the RCR paediatric trauma imaging guidelines. Of course, if there’s evidence that we’ve missed we’d love to see it! It seems reasonable to continue to develop our ultrasound skills and to pursue research into its utility but at present the evidence for using FAST in paediatric trauma just doesn’t exist.

Lastly, we touched on a shared passion: presentation skills. Ross writes a fantastic blog challenging the way we think about presentation skills and helping us to develop talks based on psychological research to improve the information transfer and retention after the talks we work so hard to write for conferences. We chatted a little about why it’s important to understand your audience and your simple, single message and how we can make our talks better.

Have a listen to the podcast below to find out more!