“What does this say about us?”: A call to action for paediatric trauma management

Ian McCafferty

Honoured as the British Society of Interventional Radiology (BSIR) travelling professor, Ian McCafferty (The Radiology Clinic, Birmingham, UK) gave the Graham Plant lecture at the BSIR annual meeting (8–10 November 2018, Newport, UK). Titled ‘Acute trauma intervention: Have we got it right?’ McCafferty’s discussion focused on paediatric interventions, posing the central question: “Can we really ignore paediatric trauma? What does it say about us if we ignore the younger generation?”

Setting out the numbers, McCafferty first highlighted a workforce consensus which was carried out by The Royal College of Radiologists in 2021, showing that there are approximately 230 interventional radiologists in the UK, with an upward trend in recent years. “But this increase is not as much as we need,” McCafferty stated, noting that this census was the first to consider paediatric interventional radiology (IR).

“By the current definition, if you do predominantly 50% of you direct clinical care as an interventional radiologist in paediatrics, [the census found] that there are currently 12 in the UK,” he told BSIR delegates. Comparing this statistic to the population of the UK, he highlight that the UK is operating via a “one in a million” paediatric IR service, showing the stark contemporary deficit in active operators. “There is a disparity between the accessibility for paediatric services,” McCafferty too making notice of the “problems” within adult IR services in the UK, as only 50% are currently able to provide 24/7 care.

Having carried out a WhatsApp survey among colleagues at several centres, McCafferty said he looked to find out what interventional radiologists are performing at their sites. “Unsurprisingly,” he found all of the adult and children, and children’s institutions had paediatric services available on site, however found that, in children’s national treatment centres (NTC), there were “very few” paediatric interventional radiologists, reducing service accessibility overall.

“I think there is an unconscious or conscious unwillingness to help,” McCafferty told delegates, reminding them of the familiar mantra which states that children should not be treated as “little adults”. “The problem with this is it induces fear and anxiety in adults potentially having to treat children who do not routinely do so. That causes a lot of anxiety, but also potentially causes trust anxiety—there are always concerns of medical and legal risks.”

Speaking on the long-term effects of the deficit in paediatric trauma management in the UK, McCafferty noted the “astronomical” economic and social burden that could occur as a result of “having trauma badly managed”, emphasising the detrimental effects that could be attributable to lack of IR access on the “developmental potential” of this “adversely affected” group.

From centre to centre, McCafferty makes clear that there is a “void” in knowledge of paediatric IR. In his understanding of the environment navigated by Alex Barnacle (Great Ormond Street Hospital, London, UK)—the 2018 BSIR Graham Plant lecturer—he stated that, when acting as travelling professor, Barnacle oftentimes was asked to speak about paediatric intervention, proving that “they are not seeing it locally”, said McCafferty.

Concluding his BSIR lecture, McCafferty bolstered his central theme, stating that paediatric IR must be recognised so that young people are not overlooked: “We have to look at ourselves and say: Can we really ignore paediatric trauma? It is not very common, which means it will present randomly at all of your centres and we must think about what this does say about us if we are ignoring the younger generation.”


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