Four-year experience of paediatric penetrating injuries: findings from a paediatric major trauma centre in the UK.

AIM: To review the experience of penetrating injury and its subsequent imaging and to discuss imaging strategies in overall trauma management in a paediatric major trauma centre. MATERIALS AND METHODS: A retrospective, single-centre study was conducted over a 4-year period (1/1/16-31/12/19) of children (<16 years old) presenting to the Emergency Department with penetrating trauma. Clinical, radiographic, and demographic data were analysed using descriptive statistics. RESULTS: Fifty-eight patients in >60 attendances were reviewed. Most (44/60, 73%) underwent some imaging, with almost half (28/60, 47%) having both computed tomography (CT) and radiography. Of cases with only a single injury site (35/60, 58%), CT was performed in 19/35 (54%) with 13/19 (68%) covering more than one body area. Of the multi-injury site cases (26/60, 42%), CT was performed in 16/25 (64%) with 14/16 (88%) involving multiple body areas. The most common injuries were solid-organ lacerations and soft-tissue and vascular injuries according to body site involved. CONCLUSION: Contrast-enhanced CT across multiple body parts should be performed for multiple stab wounds or visible injuries involving the torso. Isolated penetrating injuries may only require CT of a single body part unless the entry wound crosses body parts. An imaging algorithm is suggested, which may be applicable to other paediatric trauma units.

Systematic review and meta-analysis of the reliability and discriminative validity of cartilage compositional MRI in knee osteoarthritis.

OBJECTIVE: To assess reliability and discriminative validity of cartilage compositional magnetic resonance imaging (MRI) in knee osteoarthritis (OA). DESIGN: The study was carried out per PRISMA recommendations. We searched MEDLINE and EMBASE (1974 - present) for eligible studies. We performed qualitative synthesis of reliability data. Where data from at least two discrimination studies were available, we estimated pooled standardized mean difference (SMD) between subjects with and without OA. Discrimination analyses compared controls and subjects with mild OA (Kellgren-Lawrence (KL) grade 1-2), severe OA (KL grade 3-4) and OA not otherwise specified (NOS) where not possible to stratify. We assessed quality of the evidence using Quality Appraisal of Diagnostic Reliability (QAREL) and Quality Assessment of Diagnostic Accuracy (QUADAS-2) tools. RESULTS: Fifty-eight studies were included in the reliability analysis and 26 studies were included in the discrimination analysis, with data from a total of 2,007 knees. Intra-observer, inter-observer and test-retest reliability of compositional techniques were excellent with most intraclass correlation coefficients >0.8 and coefficients of variation <10%. T1rho and T2 relaxometry were significant discriminators between subjects with mild OA and controls, and between subjects with OA (NOS) and controls (P < 0.001). T1rho showed best discrimination for mild OA (SMD [95% CI] = 0.73 [0.40 to 1.06], P < 0.001) and OA (NOS) (0.60 [0.41 to 0.80], P < 0.001). Quality of evidence was moderate for both parts of the review. CONCLUSIONS: Cartilage compositional MRI techniques are reliable and, in the case of T1rho and T2 relaxometry, can discriminate between subjects with OA and controls.