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G94 DOES CARDIOPULMONARY RESUSCITATION CAUSE RIB FRACTURES IN CHILDREN? A SYSTEMATIC REVIEW

N. John, S. Maguire, M. K. Mann, S. Morris, A. M. Kemp, J. R. Sibert.Cardiff University, Cardiff, UK

Aim: To determine whether cardiopulmonary resuscitation (CPR) causes rib fractures in children in the context of child protection.

Methods: An all language literature search of original articles, references, textbooks, and conference abstracts 1966–2004: ASSIA, Caredata, Medline, Child Data, CINAHL, Embase, PsychINFO, SIGLE, Social Science Citation Index, and TRIP databases. We included all studies of rib fracture and CPR in children <17 years and excluded review articles and expert opinion and studies where it was not possible to establish if rib fractures pre-dated resuscitation. We used two independent reviews (a third if disputed), standardised criteria for study definition, data extraction, and critical appraisal.

Results: Of the 392 studies reviewed, five were included: four cross sectional studies and one case series. These represent data on 599 children who had CPR. Three children (0.5%) sustained rib fractures as a result of resuscitation. All three children had fractures that were anterior (two mid-clavicular and one costo-chondral). We did not find any child in the literature that had a posterior rib fracture due to CPR. Medical and non-medical personnel performed resuscitation for variable length of time. The technique used to identify rib fractures varied between studies.

Conclusion: The vast majority of children (99.5%) who undergo CPR do not develop rib fractures. When they do occur they are anterior, in contrast to posterior rib fractures, which are found in abuse. Further prospective studies of children with chest x rays prior to CPR and delayed or oblique films post resuscitation would be valuable to further clarify this question.

G95 SHOULD INFANTS AGED <1 YEAR PRESENTING WITH A HEAD INJURY HAVE A ROUTINE SKULL x ray?

G. Thomas, T. J. Ward, R. Guy, D. J. Scott.East Sussex Hospitals NHS Trust, East Sussex, UK

Aims: To evaluate the role of routine skull x ray in the …

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