Silver trauma: a study of pre- and post-COVID-19 pandemic pan-CT scanning in elderly trauma patients in a large teaching hospital.

AIM: The challenges posed by the assessment of elderly trauma patients increase the reliance on emergency CT scanning to diagnose an injury. The COVID-19 pandemic posed challenges to image service delivery. We sought to assess the effect of the COVID-19 pandemic on the imaging of elderly trauma. MATERIALS AND METHODS: All trauma patients aged 65 and over who underwent whole-body CT scanning in the same 3-month period (April-June) in 2019 and 2022 were included in our study. Data was collected on demographics, time of scanning, clinical request details and positive report findings. Anatomical injury distribution, abbreviated injury scale (AIS) and injury severity scores (ISS) were calculated. Consensus judgment was obtained on scan justification and significance of findings. Chi-squared test of association was applied to the categorical outcomes of interest. Associations were considered significant if p<0.05. RESULTS: 79 patients were scanned in the pre-pandemic assessment period versus 217 post-pandemic, an increase of 175%, including a 248% rise in fall-from-standing requests. There was a statistically significant reduction of trauma CT requests meeting fulfilment criteria post-pandemic (95% vs 83%) (p=0.008), with significantly fewer positive findings (45.6% vs 29%) (p=0.024). There was a decrease in median ISS score in the post-pandemic group (p=0.062). CONCLUSION: Despite increased scanning, there was a reduction in both the number and severity of positive traumatic imaging findings. The pandemic has increased reliance on CT without a concomitant increase in the detection of positive findings nor clinically significant findings. This single-centre study demonstrates the need to further evaluate pan-CT trauma scanning in silver trauma patients.

Survey of research participation amongst UK radiology trainees: aspirations, barriers, solutions and the Radiology Academic Network for Trainees (RADIANT).

AIM: To inform the activity of the newly formed Radiology Academic Network for Trainees (RADIANT) regarding the current level of interest, engagement, and barriers experienced by UK radiology trainees to undertake research. MATERIALS AND METHODS: A web-based survey containing nine questions was sent to the UK radiology training programme directors for distribution to trainees. The survey was also distributed to all trainee members of the RADIANT network. This led to 224 responses over a period of 2 months. RESULTS: A large proportion of respondents indicated a desire to participate in research in the next 12 months 72.3% (n=162). The most frequently reported barriers to research were lack of time (60.7%, n=136), lack of awareness of local/departmental opportunities (53.6%, n=120), and limited experience in research statistics (46%, n=103). The most favoured factor that would improve access to research was structured research training opportunities, qualified as a project with clear goals and timeline (71%, n=159), protected time for research (68.8%, n=154), and local or national trainee research networks (40.2%, n=90 and 37.1%, n=83, respectively). CONCLUSION: Many radiology trainees would like to participate in research, but multiple barriers exist. The formation of RADIANT is seen as a key part of a multifaceted approach to improving access to quality research activity alongside support from local and regional training bodies.

Preperitoneal approach for incarcerated inguinal hernia in children.

BACKGROUND/PURPOSE: The authors have been using abdominal extraperitoneal approach for treatment of incarcerated inguinal hernia in children for the last 2 years. The aim of this paper is to report on this experience. METHODS: Between March 1994 and July 1996, cases of infants and children presenting with incarcerated inguinal hernia were studied. Preperitoneal approach was used in all children who had incarcerated hernia that could not be reduced with gentle manipulation and did not reduce spontaneously under general anesthesia. There were 24 children with a median age of 12 months. RESULTS: Herniotomy, reduction of contents, and bowel resection were found to be much easier than the inguinal approach. There were no complications. CONCLUSIONS: Preperiotoneal approach appears to be a safe and easy technique for incarcerated inguinal hernia in children. The authors recommend that it should be used more commonly.

Intermittent testicular pain: fix the testes.

OBJECTIVE: To analyse the presenting features, signs and operative findings of children presenting with intermittent testicular pain, as testicular torsion is a relatively common and serious emergency in children that can lead to testicular loss in up to 80%, although half of these children have previous episodes of pain suggestive of intermittent torsion. PATIENTS AND METHODS: Data were collected prospectively for all patients presenting with recurrent pain between December 2000 and June 2001. Variables assessed included presenting symptoms, age, size, lie and position of the testis when supine and erect, the operative findings and follow-up. RESULTS: Eight children had at least two previous episodes of testicular pain; four of these were admitted on six occasions. Two had undergone previous scrotal exploration. On clinical examination, six boys had a transverse testicle and two a discrepancy in testicular size. All children had their testes fixed. At operation in all patients there was abnormal attachment of the tunica vaginalis with a typical 'bell clapper' deformity. On follow-up only one patient still complains of pain. CONCLUSION: In view of high incidence of abnormalities we consider that to improve the testicular salvage rate and prevent testicular atrophy, bilateral testicular fixation is recommended for boys with intermittent testicular pain and positive clinical findings.