RESUMO
INTRODUCTION: Media interest in inter-juvenile violence in the UK has emphasised to clinicians the lack of data on medical outcomes following injury. A study was undertaken to examine the incidence of childhood head injury in a large trauma centre serving an inner city multiethnic community. The aim was to establish the physical and financial cost of survival with a head injury following inter-juvenile assault. METHODS: All children aged 8-16 years attending King's College Hospital, London (KCH) because of a head injury were identified restrospectively. The case notes of those admitted to the neurosurgical and neurorehabilitation service with a head injury between 1 August 2006 and 30 September 2008 were reviewed. RESULTS: A total of 1126 children attended KCH with a head injury. Eight boys required admission for treatment of a head injury following alleged inter-juvenile assault. The mechanisms of brain injury included a penetrating knife wound, assault with a bottle and physical assault. One child died following admission as a result of his brain injury. Complete neurological outcome data were available on six cases. Three had a hemiplegia, four had speech and language difficulties, two had visual impairment, five had behavioural changes and five had cognitive difficulties. CONCLUSIONS: This study demonstrates the serious consequences of inter-juvenile assault. Survival can be associated with neurological and psychological deficits. The cost to the health service is substantial. Further work is required to establish the long-term needs of these children.
Assuntos
Lesões Encefálicas , Custos de Cuidados de Saúde/estatística & dados numéricos , Adolescente , Lesões Encefálicas/complicações , Lesões Encefálicas/economia , Lesões Encefálicas/psicologia , Lesões Encefálicas/reabilitação , Área Programática de Saúde , Criança , Serviço Hospitalar de Emergência/estatística & dados numéricos , Família , Humanos , Londres , Masculino , Avaliação de Resultados em Cuidados de Saúde , Admissão do Paciente/estatística & dados numéricos , ViolênciaRESUMO
AIM: This article describes the current magnetic resonance imaging (MRI) sedation service, the role of the nurse sedationist, results of clinical audits, and future issues within MRI. METHOD: Data from 2004 until 2006 were analysed to describe the percentage of children who were successfully sedated, and any complications. The recovery profile was investigated by a questionnaire of 100 consecutive cases. FINDINGS: Sedation was attempted in 455 cases with chloral hydrate, and 325 with temazepam and droperidol. The success rate was 97.4 and 92.6 per cent respectively. Top-up sedation was used in 10 and 29 per cent respectively. There were seven minor incidents but none required admission. Approximately 20 per cent of children were drowsy the following day. CONCLUSION: We believe that the success of the service depends upon three main factors: the deselection of children in whom sedation is unsafe or likely to be unsuccessful, the use of appropriate drugs in limited doses, and the training of experienced nurses.