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Stilwell PA, White B, Graham C, Rigby E, Shield JPH, Brandreth R, Solti S, Owen R, Kenny S. National consensus to develop core outcomes for the evaluation of complications from excess weight (CEW) clinics: results of a national Delphi process. Arch Dis Child 2023; 108:296-299. [PMID: 36599626 DOI: 10.1136/archdischild-2022-324550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 12/15/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE In 2021, centres across all seven NHS-England regions were selected to develop pilot clinics with the aim of treating children and young people (CYP) living with complications relating to excess weight (CEW). We led a process to develop core outcomes to enable the evaluation of these clinics. METHODS A two-round Delphi process, virtual steering group meetings and two patient representation workshops were used to agree the most important outcomes for both clinicians/allied professionals and representative prospective service users. RESULTS A total of 119 clinicians/allied professionals were invited to contribute to the Delphi process: 62 (52%) agreed and completed round 1 and 47 of these (76%) went on to complete round 2. Six young people (age range 13-17 years) and six parents were involved in two patient representation workshops and their experiences fed into virtual steering group meetings, via a representative.There were 44 outcomes assessed in round 1 and 21 outcomes assessed in round 2. There were 16 core outcomes selected: anthropometric, glucose tolerance/insulin resistance/type 2 diabetes, blood pressure, lipid profile, breathing problems, identification of aetiology, non-alcoholic fatty liver disease, idiopathic intracranial hypertension, anxiety, depression, self-esteem, quality of life, school attendance, dietary habits including disordered eating, exercise and activity habits. CONCLUSIONS Use of an online Delphi process, patient representation workshops and virtual steering group meetings has enabled the development of core outcomes for clinical obesity services with eight physical health, five mental health and three self-management outcomes. Further work is needed to develop outcome measures to complete a core outcome set. These will be used to guide the evaluation of novel regional clinics for the treatment of complications of excess weight.
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Affiliation(s)
- Philippa Anna Stilwell
- NHS England and NHS Improvement London, London, UK
- Paediatrics, Evelina London Children's Healthcare, London, UK
| | - Billy White
- University College London Hospital-Great Ormond Street Obesity Service, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Emma Rigby
- Association for Young People's Health, London, UK
| | - Julian P H Shield
- NIHR Bristol Biomedical Research Centre, University Hospitals of Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
- Institute of Child Health, University of Bristol, Bristol, UK
| | - Rachael Brandreth
- NHS England and NHS Improvement London, London, UK
- Dietetics, Royal Cornwall Hospitals Trust, Cornwall, UK
| | - Sophie Solti
- NHS England and NHS Improvement London, London, UK
| | - Richard Owen
- NHS England and NHS Improvement London, London, UK
| | - Simon Kenny
- NHS England and NHS Improvement London, London, UK
- Paediatric Surgery, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
- School of Life Sciences, University of Liverpool, Liverpool, England
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Zylbersztejn A, Stilwell PA, Zhu H, Ainsworth V, Allister J, Horridge K, Stephenson T, Wijlaars L, Gilbert R, Heys M, Hardelid P. Trends in hospital admissions during transition from paediatric to adult services for young people with learning disabilities or autism: Population-based cohort study. Lancet Reg Health Eur 2023; 24:100531. [PMID: 36394000 PMCID: PMC9649375 DOI: 10.1016/j.lanepe.2022.100531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/22/2022] [Accepted: 10/03/2022] [Indexed: 11/11/2022] Open
Abstract
Background Transition from paediatric to adult health care may disrupt continuity of care, and result in unmet health needs. We describe changes in planned and unplanned hospital admission rates before, during and after transition for young people with learning disability (LD), or autism spectrum disorders (ASD) indicated in hospital records, who are likely to have more complex health needs. Methods We developed two mutually exclusive cohorts of young people with LD, and with ASD without LD, born between 1990 and 2001 in England using national hospital admission data. We determined the annual rate of change in planned and unplanned hospital admission rates before (age 10–15 years), during (16–18 years) and after (19–24 years) transition to adult care using multilevel negative binomial regression models, accounting for area-level deprivation, sex, birth year and presence of comorbidities. Findings The cohorts included 51,291 young people with LD, and 46,270 autistic young people. Admission rates at ages 10–24 years old were higher for young people with LD (54 planned and 25 unplanned admissions per 100 person-years) than for autistic young people (17/100 and 16/100, respectively). For young people with LD, planned admission rates were highest and constant before transition (rate ratio [RR]: 0.99, 95% confidence interval [CI] 0.98–0.99), declined by 14% per year of age during (RR: 0.86, 95% CI: 0.85–0.88), and remained constant after transition (RR: 0.99, 95% CI: 0.99–1.00), mainly due to fewer admissions for non-surgical care, including respite care. Unplanned admission rates increased by 3% per year of age before (RR: 1.03, 95% CI: 1.02–1.03), remained constant during (RR: 1.01, 95% CI: 1.00–1.03) and increased by 3% per year after transition (RR: 1.03, 95% CI: 1.02–1.04). For autistic young people, planned admission rates increased before (RR: 1.06, 95% CI: 1.05–1.06), decreased during (RR: 0.95, 95% CI: 0.93–0.97), and increased after transition (RR: 1.05, 95%: 1.04–1.07). Unplanned admission rates increased most rapidly before (RR: 1.16, 95% CI: 1.15–1.17), remained constant during (RR: 1.01, 95% CI: 0.99–1.03), and increased moderately after transition (RR: 1.03, 95% CI: 1.02–1.04). Interpretation Decreases in planned admission rates during transition were paralleled by small but consistent increases in unplanned admission rates with age for young people with LD and autistic young people. Decreases in non-surgical planned care during transition could reflect disruptions to continuity of planned/respite care or a shift towards provision of healthcare in primary care and community settings and non-hospital arrangements for respite care. Funding National Institute for Health Research Policy Research Programme.
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Stilwell PA, Stuttard G, Scott-Jupp R, Boyle A, Kenny S, Maconochie I. Paediatric NHS 111 Clinical Assessment Services pilot: an observational study. Arch Dis Child 2022; 107:e14. [PMID: 34876400 DOI: 10.1136/archdischild-2021-322908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 11/14/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine the feasibility and impact of having paediatric clinicians working in the Clinical Assessment Services (CAS) within NHS 111, a national telephone advice service. DESIGN Observational study. SETTING Six NHS 111 providers across England with CAS where volunteer paediatric clinicians (doctors and advanced nurse practitioners (ANPs)) worked between May and December 2020. A data reporting framework was used to compare the outcomes of calls taken by paediatric vs non-paediatric clinicians. PATIENTS Under 16-year-olds prompting calls to NHS 111 over the study period. MAIN OUTCOME MEASURES The disposition (final outcome of calls) taken by paediatric versus non-paediatric clinicians, paediatric clinicians' and patient experience. RESULTS 70 paediatric clinicians (66 doctors and 4 ANPs) worked flexible shifts in six NHS 111 providers' CAS over the study period: 2535 calls for under 16-year-olds were taken by paediatric clinicians and 137 008 by non-paediatric clinicians. Overall, disposition rates differed significantly between the calls taken by paediatric versus (vs) non-paediatric clinicians: 69% vs 43% were advised on self-care only, 13% vs 18% to attend emergency departments (EDs), 13% vs 29% to attend primary care, 1% vs 4% to receive an urgent ambulance call out and 4% vs 6% referred to another health service, respectively. When compared with recent (all age) national whole data sets, the feedback from calls taken by paediatricians noted a greater proportion of patients/carers reporting that their problem was fully resolved (92% vs 27%). CONCLUSIONS Introducing paediatric specialists into NHS 111 CAS is likely to increase self-care dispositions, and reduce onward referrals to primary care, ED and ambulances. Future work will evaluate the impact of a national paediatric clinical assessment service to which specific case types are streamed.
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Affiliation(s)
- Philippa Anna Stilwell
- Children and Young People's Transformation Team, NHS England and NHS Improvement London, London, UK.,Community Child Health, Evelina London Children's Hospital, London, UK
| | - Gareth Stuttard
- Urgent and Emergency Care, NHS England and NHS Improvement Midlands, Birmingham, UK.,General Practice, Wake Green Surgery, Birmingham, UK
| | | | - Adrian Boyle
- Emergency Department, Cambridge University Hospitals Foundation Trust, London, UK
| | - Simon Kenny
- Children and Young People's Transformation Team, NHS England and NHS Improvement London, London, UK.,Paediatric Surgery, Alder Hey Children's NHS Foundation Trust, Liverpool, Merseyside, UK
| | - Ian Maconochie
- Children and Young People's Transformation Team, NHS England and NHS Improvement London, London, UK .,Paediatric Emergency Department, St Mary's Hospital, London, UK
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Stilwell PA, Fissler S, Burkitt S, Smith B, Stuttard G, Kenny S, Evans D, Maconochie I. NHS 111 Clinical Assessment Services: paediatric consultations. Arch Dis Child 2022; 107:e13. [PMID: 34697025 DOI: 10.1136/archdischild-2021-322909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 10/04/2021] [Indexed: 11/04/2022]
Abstract
Around the UK, commissioners have different models for delivering NHS 111, General Practice (GP) out-of-hours and urgent care services, focusing on telephony to help deliver urgent and emergency care. During the (early phases of the) COVID-19 pandemic, NHS 111 experienced an unprecedented volume of calls. At any time, 25%-30% of calls relate to children and young people (CYP). In response, the CYP's Transformation and Integrated Urgent Care teams at NHS England and NHS Improvement (NHSE/I) assisted in redeploying volunteer paediatricians into the integrated urgent care NHS 111 Clinical Assessment Services (CAS), taking calls about CYP. From this work, key stakeholders developed a paediatric 111 consultation framework, as well as learning outcomes, key capabilities and illustrations mapped against the Royal College of Paediatrics and Child Health (RCPCH) Progress curriculum domains, to aid paediatricians in training to undertake NHS 111 activities. These learning outcomes and key capabilities have been endorsed by the RCPCH Curriculum Review Group and are recommended to form part of the integrated urgent care service specification and workforce blueprint to improve outcomes for CYP.
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Affiliation(s)
| | - Sarah Fissler
- Paediatric Emergency Medicine, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Sarah Burkitt
- Paediatric Emergency Medicine, Evelina London Children's Hospital, London, UK
| | - Bethany Smith
- Imperial Academic Health Sciences Centre, Imperial College London, London, UK
| | | | - Simon Kenny
- Paediatric Surgery, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - David Evans
- Neonatal Department, Southmead Hospital, Bristol, UK
| | - Ian Maconochie
- Paediatric Emergency Medicine, St Mary's Hospital, London, UK
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5
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Stilwell PA, Munro APS, Basatemur E, Talawila Da Camara N, Harwood R, Roland D. Bibliography of published COVID-19 in children literature. Arch Dis Child 2022; 107:168-172. [PMID: 33958347 DOI: 10.1136/archdischild-2021-321751] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 04/14/2021] [Accepted: 04/25/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND The COVID-19 pandemic is the biggest worldwide health challenge in this century. Research concerning the role of children in the spread of SARS-CoV-2, and investigating the clinical effects of infection in children, has been vital. This paper describes the publication trend for pertinent scientific literature relating to COVID-19 in children during the first 6 months of the pandemic. METHODS A comprehensive search of preprint and published literature was conducted daily across four databases (PubMed, Scopus, Ovid-Embase and MedRXiv) between 1 January 2020 and 30 June 2020. Titles and abstracts were screened against predefined inclusion and exclusion criteria. FINDINGS Over the study period, a total of 45 453 papers were retrieved, of which 476 met our inclusion criteria. The cumulative number of children described in included publications totalled (at most) 41 396. The median number of children per paper was 6 (IQR 1-33). Nearly one-third of papers (30.2%) reported on a single child, and a further 28.3% reported on between 1 and 9 children. Half of all the publications originated from Asia. INTERPRETATION Our prospective bibliographic analysis of paediatric COVID-19 publications demonstrated a steady increase in the number of papers over time. Understanding and policy evolved with new information that was gathered over the course of the study period. However, over half of publications were individual case reports or small case series, which may have had a limited contribution to advancement of knowledge. During a pandemic, literature should be interpreted with great caution, and clinical/policy decisions should be continually reviewed in light of emerging evidence.
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Affiliation(s)
| | - Alasdair P S Munro
- NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK .,Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, Hampshire, UK
| | - Emre Basatemur
- UCL Great Ormond Street Institute of Child Health Population Policy and Practice, London, UK
| | | | - Rachel Harwood
- Department of Paediatric Surgery, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.,Department of Cellular and Molecular Physiology, University of Liverpool, Liverpool, UK
| | - Damian Roland
- Department of Health Sciences, University of Leicester, Leicester, UK.,Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, University Hospitals of Leicester NHS Trust, Leicester, UK
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Roland D, Stilwell PA, Fortune PM, Alexander J, Clark SJ, Kenny S. Case for change: a standardised inpatient paediatric early warning system in England. Arch Dis Child 2021; 106:648-651. [PMID: 33419727 DOI: 10.1136/archdischild-2020-320466] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 12/13/2020] [Indexed: 11/03/2022]
Abstract
Most children in hospital who are clinically deteriorating are monitored regularly, and their treatment is escalated effectively. However a small, but significant, number of deteriorating children experience suboptimal outcomes because of a failure to recognise and respond to acute deterioration early enough leading to unintended harm. Tragically this occasionally can have fatal consequences. Investigations into these rare events highlight common themes of missed early signs of deterioration in children, prompting regulatory agencies to suggest paediatric early warning systems (PEWS) to aid clinical practice. In England, track and trigger tools (TTT), which are one facet of PEWS have been widely rolled out but in a heterogeneous fashion. The evidence for TTT is mixed but they are complex interventions and current outcomes do not fully define the entirety of their potential impact. This article explains the rationale behind the decision of the NHS England and NHS Improvement, Royal College of Paediatrics and Child Health and Royal College of Nursing to implement a standardised inpatient PEWS as part of a system-wide paediatric observations tracking system in England and how this fits into a wider programme of activity.
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Affiliation(s)
- Damian Roland
- SAPPHIRE Group, Health Sciences, University of Leicester, Leicester, UK .,Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - Peter-Marc Fortune
- Paediatric Intensive Care Unit, Royal Manchester Children's Hospital, Manchester, UK
| | - John Alexander
- Child Health, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Simon J Clark
- Jessop Wing, Neonatal Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Simon Kenny
- Department of Paediatric Surgery, Alderhey Children's NHS Foundation Trust, Liverpool, UK
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Affiliation(s)
- Jayne Wheway
- Patient Safety Team, NHS England and NHS Improvement, London, UK
| | - Philippa Anna Stilwell
- Children and Young People's Transformation Team, NHS England and NHS Improvement, London, UK
| | - Adam Cook
- Patient Safety Measurement Unit, NHS England and NHS Improvement, London, UK
| | - Damian Roland
- SAPPHIRE Group, Health Sciences, University of Leicester, Leicester, UK .,Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, University of Leicester, Leicester, UK
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Stilwell PA, Elbakry M. A foot toe remember. Arch Dis Child 2020; 105:1107. [PMID: 31296596 DOI: 10.1136/archdischild-2019-317377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/28/2019] [Indexed: 11/04/2022]
Affiliation(s)
| | - Mariam Elbakry
- Neonatal Department, Northwick Park Hospital, London, UK
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Rees P, Stilwell PA, Bolton C, Akillioglu M, Carter B, Gale C, Sutcliffe A. Childhood Health and Educational Outcomes After Neonatal Abstinence Syndrome: A Systematic Review and Meta-analysis. J Pediatr 2020; 226:149-156.e16. [PMID: 32659230 DOI: 10.1016/j.jpeds.2020.07.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 06/30/2020] [Accepted: 07/02/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To systematically review and meta-analyze the association between neonatal abstinence syndrome (NAS) and adverse health or educational childhood outcomes. STUDY DESIGN An all-language search was conducted across 11 databases between January 1, 1975, and September 3, 2019; 5865 titles were identified. Observational studies of children between 28 days and 16 years of age, in whom a diagnosis of NAS was documented, were included. Outcomes included reasons for hospital admissions, childhood diagnoses, developmental outcomes, and academic attainment scores. All studies underwent independent review by 2 trained reviewers, who extracted study data and assessed risk of bias using the Newcastle Ottawa Tool. RESULTS Fifteen studies were identified that included 10 907 children with previous NAS and 1 730 213 children without previous NAS, aged 0-16 years. There was a strong association between NAS and subsequent child maltreatment (aOR, 6.49; 95% CI, 4.46-9.45; I2 = 52%), injuries and poisoning (aOR, 1.34; 95% CI, 1.21-1.49; I2 = 0%), and a variety of mental health conditions. Studies consistently demonstrated an increased incidence of strabismus and nystagmus among those with previous NAS. Children with NAS also had lower mean academic scores than the control group in every domain of testing across age groups. CONCLUSIONS NAS is significantly associated with future child maltreatment, mental health diagnoses, visual problems, and poor school performance. Owing to the necessary inclusion of nonrandomized studies, incomplete reporting among studies, and likely unadjusted confounding, this review does not suggest causation. However, we highlight associations requiring further investigation and targeted intervention, to positively impact the life course trajectories of this growing population of children.
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Affiliation(s)
- Philippa Rees
- Population Policy Practice, NIHR BRC UCL Institute of Child Health, University College London, UK.
| | | | - Chrissy Bolton
- Whittington Health National Health Service Trust, London, UK
| | | | - Ben Carter
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Chris Gale
- Neonatal Medicine, School of Public Health, Imperial College London, UK
| | - Alastair Sutcliffe
- Population Policy Practice, NIHR BRC UCL Institute of Child Health, University College London, UK
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Stilwell PA, Robertson F, Bhate S, Sutcliffe AG. A child in shock: carotid blowout syndrome. Arch Dis Child Educ Pract Ed 2020; 105:177-184. [PMID: 31401552 DOI: 10.1136/archdischild-2019-317052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 07/18/2019] [Accepted: 07/21/2019] [Indexed: 11/04/2022]
Abstract
Paediatricians commonly encounter neck lumps during their routine clinical practice; vascular abnormalities, such as (pseudo)aneurysms, are a rare cause of these. Pseudoaneurysms of the carotid artery in children are usually the result of blunt or penetrating trauma, infection or vasculitis/connective tissue disorders. They can present with a variety of symptoms including neck pain, as a pulsatile neck mass or with compressive symptoms (for example, cranial nerve palsies or dyspnoea). Pseudoaneurysms carry a risk of rupture in which case they are fatal, unless immediate treatment is provided.We report a 17-month-old male child with idiopathic carotid artery blowout syndrome presenting with acute oropharyngeal haemorrhage leading to asystolic cardiac arrest. He was successfully resuscitated and emergency embolisation controlled the bleeding. Despite extensive left hemispheric infarct, he has survived.Carotid artery blowout syndrome needs to be recognised as a potential cause of major haemorrhage in childhood. The purpose of this case report is to remind readers of the differential diagnosis and work-up of a child presenting with a neck lump, to highlight important aspects of the acute management of major haemorrhage and massive blood transfusion in paediatrics, to describe the aetiology, presentation and management of carotid artery pseudoaneurysm in children and to discuss long term rehabilitation in patients with consequent neurological sequelae (including the need for input from multiple specialty teams).
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Affiliation(s)
| | - Fergus Robertson
- Fergus Robertson: Neuroradiology. Sanjay Bhate: Neurology, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Sanjay Bhate
- Fergus Robertson: Neuroradiology. Sanjay Bhate: Neurology, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
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Affiliation(s)
- Philippa Anna Stilwell
- General Paediatrics, University College London Hospitals NHS Foundation Trust, London, UK
| | - Debra Fine
- GPVTS, University College London Hospitals NHS Foundation Trust, London, UK
| | - James Roberts
- Radiology Department, University College London Hospitals NHS Foundation Trust, London, UK
| | - Leanne Goh
- General Paediatrics, University College London Hospitals NHS Foundation Trust, London, UK
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Affiliation(s)
- Michael J Carter
- Department of Women and Children's Health, King's College London, London, UK.,Children and Young People's Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Philippa Anna Stilwell
- Children and Young People's Services, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Sarah Eisen
- Children and Young People's Services, University College London Hospitals NHS Foundation Trust, London, UK
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