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Abstracts from the Northern Undergraduate Child Health Conference
ABSTRACTS
specific and diagnosis may be delayed. In 2011 an evidencebased guideline, HEADSMART, was introduced to aid clinicians and the public with symptom recognition, and to facilitate early referral and diagnosis.
Abstracts from the Northern Undergraduate Child Health Conference
Aims: This study aims to examine the relationship between delayed diagnosis and neurological outcome, and evaluate the potential impact of the guidelines for these patients.
Saturday, March 16th, 2013
Methods: Clinical records for 55 children diagnosed with CNS tumours in 2002-2007 and treated at the Royal Hospital for Sick Children, Edinburgh were retrospectively reviewed. Data on presenting symptoms, referral pathway, treatment and neurological outcomes was extracted. HEADSMART guidelines were applied retrospectively to patient data.
An audit of re-attendances to Sunderland Royal Hospital Paediatric accident and emergency (SRH-PED) in December 2012 Alexander White, 4th Year Medical Student, Newcastle University, UK Supervisor: Dr Myra Herbert, Sunderland Royal Hospital, UK
Results: Thirty-nine patients were alive at the time of the review. 90% had at least one ongoing clinical problem at last assessment. Median prediagnostic symptom interval (PSI) was 90 days, including both parental and doctor delays. Strong correlation between increased PSI and adverse visual and motor outcomes was observed. If HEADSMART guidelines had been used at the time of presentation, a potential 71.5 days delay per patient could have been avoided.
Objective: To determine whether SRH-PED meets the standards of two college of emergency medicine (CEM) quality indicators for unplanned re-attendance and senior review of high risk patients. Methodology: Retrospective study using data collected from SRH-PED IT and paper records. The inclusion criterion was reattendance to SRH-PED in December 2012 (n¼290, 349 readmissions).
Conclusions: Delayed diagnosis of CNS tumours was associated with poorer long-term outcome in terms of motor and visual function. The new guideline represents an opportunity for reduction in delay and should be used for education of both clinicians and the general public.
Main outcome measures: Between 1-5% of all admissions should be unplanned re-attendances within 7 days of the first admission. A figure higher than 5% is likely reflective of poor quality care. A figure lower than 1% would reflect a risk averse care approach and an inappropriately high admission rate. Each patient that re-attends with a related condition, without prior planning and within 72 hours, should be reviewed by a senior (ST3þ).
Audit of acute paediatric pain management in accident and emergency
Results: By comparing unplanned re-attendances (191) to the total number of patients (2680) that attended SRH-PED the CEM parameter was calculated at 7.12%. There were 105 patients meeting the inclusion criteria for the consultant sign off quality indicator. 14% saw a consultant and 34% saw either a consultant or registrar.
John F. Cleland, Dr. George Rylance Royal Victoria Infirmary, Newcastle University, UK
Conclusions: A new IT system will soon be installed which includes entries specific to unplanned re-attendance and senior review. A re-audit should be carried out to discern if the results are accurate. The primary finding is that documentation in SRHPED is unclear. The high level of unplanned re-attendance and low rate of senior reviews may be artefacts of this lack of clarity.
Aim: To discover whether acute pain in children is being managed according to the guidelines1. A pain score recorded at triage and children in moderate to severe pain given analgesia within 20 minutes of arrival.
Background: Acute pain is one of the most common reasons for presentation to A&E. In the past pain in children has been under recognised and under treated.
Methodology: A prospective study over two weeks (14.01.1325.01.13) of 61 children presenting to A&E with painful noninflammatory conditions: fracture, laceration, soft tissue injury, head injury.
Time to diagnosis of childhood CNS tumours and subsequent neurodisability: an audit of patients diagnosed 2002-2007 in South East Scotland 1
2
Anya Stephenson , Dr. Mark Brougham , Dr. Emma Moore University of Edinburgh, Edinburgh, UK 2 Royal Hospital for Sick Children, Edinburgh, UK
Results: No pain scores were recorded. Of the 61 patients, 20% received no analgesia. Of those 31 patients that received analgesia in hospital 39% were not treated within 20 minutes.
2
1
Discussion: The results show that some patients are not receiving analgesia, this could be due to an under recognition of pain. No pain scores were recorded so it is impossible to tell
Background: Central nervous system (CNS) tumours account for 1 in 4 childhood cancers. Presenting symptoms are often non-
PAEDIATRICS AND CHILD HEALTH 23:7
329
Ó 2013 Published by Elsevier Ltd.
ABSTRACTS
REFERENCES
whether the children were in pain to begin with and whether analgesia was effective. Those who received no analgesia may have been given advice on analgesia to give at home, rather than have something prescribed. It was only possible to record the time of prescription, not the time of administration which could affect the results.
1. Asthma UK, 2012. Facts for Journalists. [Online] Available at:.
Conclusion: The guidelines are not being met, meaning children are being left in pain. Improvements need to be made in recognition and management of acute pain.
Management of paracetamol overdose in the Great North Children’s Hospital during 2012
An audit of paediatric asthma management against CDDFT (County Durham and Darlington Foundation Trust) guidelines
Sophie Spooner Great North Children’s Hospital (Royal Victoria Infirmary), Newcastle University, UK
Ruth Collins University Hospital of North Durham, Newcastle University, UK
Background: Paracetamol overdose (OD) is common and potentially fatal. Nationwide, Toxbase guidelines direct decisions on admission and treatment with N-acetylcysteine. While undertreatment risks liver damage, inappropriate treatment and avoidable admissions also affect patient safety and entail significant costs to the NHS.
Background: Asthma affects approximately one in eleven children in the UK, over 30,000 paediatric hospital admissions per annum are attributable to asthma(1). The British Thoracic Society (BTS) has a treatment protocol for the management of exacerbations however this protocol does not give specific instructions such as a timeframe for drug administration(2). The CDDFT therefore set up a ‘Standards of Care Guideline’ for the management of acute asthma in children.
Aims: To assess adherence of Great North Children’s Hospital (GNCH) to the Toxbase guidelines on management of paracetamol OD.
Aims: This audit aims to assess the level of adherence to the trust guidelines and make recommendations to achieve higher compliance.
Methods: The audit was registered with Newcastle NHS Trust. The sample comprised 48 patients admitted during 2012 to the GNCH for ‘Poison by aminophenol derivative, T391.’ A pro forma was used to collect data from paper notes and electronic records. Data was analysed to determine whether admission was ‘necessary’ or ‘unnecessary’ and whether treatment was ‘appropriate’ or ‘inappropriate’ as defined by Toxbase.
Methods: Location: All CDDFT hospitals with children’s units. Time period: 1/10/12-30/11/12. Criteria: Patients discharged with asthma 16 (30 patients). Design: Retrospective study from patient notes. Results: No admission met all the 16 recommended guidelines. On average 47.2% compliance was achieved. One of the main areas of non-compliance was the administration of bronchodilators within 15 minutes (24% compliance) and steroids within one hour (20% compliance). The recommendation to take observations hourly for four hours only occurred in 10% patients. 57% patients received observations at 4 hourly intervals throughout admission. Reassessment rates were low with 28% patient being reassessed within 20 minutes of their bronchodilator.
Results: 47/48 notes were available for analysis (female¼44, male¼3, mean age 11.3 years). 33 admissions were after deliberate OD while 14 were after accidental OD. 23% of admissions were unnecessary; the ODs were accidental and less than 75mg/kg. 9 patients were treated with N-acetylcysteine, 22% of these were treated inappropriately as the paracetamol level was sampled before accurate analysis was possible (<4 hours). Investigations recommended by Toxbase were inconsistently performed; venous bicarbonate and International Normalised Ratio (INR) were carried out just in 25.5% of cases.
Conclusions: This audit highlighted many of the guidelines were not being followed; therefore the following recommendations were made. Display and publish guidelines prominently. Highlight the importance of rapid review of asthmatic children. Re-audit in one year to reassess compliance.
PAEDIATRICS AND CHILD HEALTH 23:7
Conclusions: By Toxbase standards, some patients were admitted unnecessarily after accidental paracetamol overdose and there were instances in which N-acetylcysteine was prescribed inappropriately. Additionally, recommended biochemical investigations were frequently not performed. A
330
Ó 2013 Published by Elsevier Ltd.
specific and diagnosis may be delayed. In 2011 an evidencebased guideline, HEADSMART, was introduced to aid clinicians and the public with symptom recognition, and to facilitate early referral and diagnosis.
Abstracts from the Northern Undergraduate Child Health Conference
Aims: This study aims to examine the relationship between delayed diagnosis and neurological outcome, and evaluate the potential impact of the guidelines for these patients.
Saturday, March 16th, 2013
Methods: Clinical records for 55 children diagnosed with CNS tumours in 2002-2007 and treated at the Royal Hospital for Sick Children, Edinburgh were retrospectively reviewed. Data on presenting symptoms, referral pathway, treatment and neurological outcomes was extracted. HEADSMART guidelines were applied retrospectively to patient data.
An audit of re-attendances to Sunderland Royal Hospital Paediatric accident and emergency (SRH-PED) in December 2012 Alexander White, 4th Year Medical Student, Newcastle University, UK Supervisor: Dr Myra Herbert, Sunderland Royal Hospital, UK
Results: Thirty-nine patients were alive at the time of the review. 90% had at least one ongoing clinical problem at last assessment. Median prediagnostic symptom interval (PSI) was 90 days, including both parental and doctor delays. Strong correlation between increased PSI and adverse visual and motor outcomes was observed. If HEADSMART guidelines had been used at the time of presentation, a potential 71.5 days delay per patient could have been avoided.
Objective: To determine whether SRH-PED meets the standards of two college of emergency medicine (CEM) quality indicators for unplanned re-attendance and senior review of high risk patients. Methodology: Retrospective study using data collected from SRH-PED IT and paper records. The inclusion criterion was reattendance to SRH-PED in December 2012 (n¼290, 349 readmissions).
Conclusions: Delayed diagnosis of CNS tumours was associated with poorer long-term outcome in terms of motor and visual function. The new guideline represents an opportunity for reduction in delay and should be used for education of both clinicians and the general public.
Main outcome measures: Between 1-5% of all admissions should be unplanned re-attendances within 7 days of the first admission. A figure higher than 5% is likely reflective of poor quality care. A figure lower than 1% would reflect a risk averse care approach and an inappropriately high admission rate. Each patient that re-attends with a related condition, without prior planning and within 72 hours, should be reviewed by a senior (ST3þ).
Audit of acute paediatric pain management in accident and emergency
Results: By comparing unplanned re-attendances (191) to the total number of patients (2680) that attended SRH-PED the CEM parameter was calculated at 7.12%. There were 105 patients meeting the inclusion criteria for the consultant sign off quality indicator. 14% saw a consultant and 34% saw either a consultant or registrar.
John F. Cleland, Dr. George Rylance Royal Victoria Infirmary, Newcastle University, UK
Conclusions: A new IT system will soon be installed which includes entries specific to unplanned re-attendance and senior review. A re-audit should be carried out to discern if the results are accurate. The primary finding is that documentation in SRHPED is unclear. The high level of unplanned re-attendance and low rate of senior reviews may be artefacts of this lack of clarity.
Aim: To discover whether acute pain in children is being managed according to the guidelines1. A pain score recorded at triage and children in moderate to severe pain given analgesia within 20 minutes of arrival.
Background: Acute pain is one of the most common reasons for presentation to A&E. In the past pain in children has been under recognised and under treated.
Methodology: A prospective study over two weeks (14.01.1325.01.13) of 61 children presenting to A&E with painful noninflammatory conditions: fracture, laceration, soft tissue injury, head injury.
Time to diagnosis of childhood CNS tumours and subsequent neurodisability: an audit of patients diagnosed 2002-2007 in South East Scotland 1
2
Anya Stephenson , Dr. Mark Brougham , Dr. Emma Moore University of Edinburgh, Edinburgh, UK 2 Royal Hospital for Sick Children, Edinburgh, UK
Results: No pain scores were recorded. Of the 61 patients, 20% received no analgesia. Of those 31 patients that received analgesia in hospital 39% were not treated within 20 minutes.
2
1
Discussion: The results show that some patients are not receiving analgesia, this could be due to an under recognition of pain. No pain scores were recorded so it is impossible to tell
Background: Central nervous system (CNS) tumours account for 1 in 4 childhood cancers. Presenting symptoms are often non-
PAEDIATRICS AND CHILD HEALTH 23:7
329
Ó 2013 Published by Elsevier Ltd.
ABSTRACTS
REFERENCES
whether the children were in pain to begin with and whether analgesia was effective. Those who received no analgesia may have been given advice on analgesia to give at home, rather than have something prescribed. It was only possible to record the time of prescription, not the time of administration which could affect the results.
1. Asthma UK, 2012. Facts for Journalists. [Online] Available at:
Conclusion: The guidelines are not being met, meaning children are being left in pain. Improvements need to be made in recognition and management of acute pain.
Management of paracetamol overdose in the Great North Children’s Hospital during 2012
An audit of paediatric asthma management against CDDFT (County Durham and Darlington Foundation Trust) guidelines
Sophie Spooner Great North Children’s Hospital (Royal Victoria Infirmary), Newcastle University, UK
Ruth Collins University Hospital of North Durham, Newcastle University, UK
Background: Paracetamol overdose (OD) is common and potentially fatal. Nationwide, Toxbase guidelines direct decisions on admission and treatment with N-acetylcysteine. While undertreatment risks liver damage, inappropriate treatment and avoidable admissions also affect patient safety and entail significant costs to the NHS.
Background: Asthma affects approximately one in eleven children in the UK, over 30,000 paediatric hospital admissions per annum are attributable to asthma(1). The British Thoracic Society (BTS) has a treatment protocol for the management of exacerbations however this protocol does not give specific instructions such as a timeframe for drug administration(2). The CDDFT therefore set up a ‘Standards of Care Guideline’ for the management of acute asthma in children.
Aims: To assess adherence of Great North Children’s Hospital (GNCH) to the Toxbase guidelines on management of paracetamol OD.
Aims: This audit aims to assess the level of adherence to the trust guidelines and make recommendations to achieve higher compliance.
Methods: The audit was registered with Newcastle NHS Trust. The sample comprised 48 patients admitted during 2012 to the GNCH for ‘Poison by aminophenol derivative, T391.’ A pro forma was used to collect data from paper notes and electronic records. Data was analysed to determine whether admission was ‘necessary’ or ‘unnecessary’ and whether treatment was ‘appropriate’ or ‘inappropriate’ as defined by Toxbase.
Methods: Location: All CDDFT hospitals with children’s units. Time period: 1/10/12-30/11/12. Criteria: Patients discharged with asthma 16 (30 patients). Design: Retrospective study from patient notes. Results: No admission met all the 16 recommended guidelines. On average 47.2% compliance was achieved. One of the main areas of non-compliance was the administration of bronchodilators within 15 minutes (24% compliance) and steroids within one hour (20% compliance). The recommendation to take observations hourly for four hours only occurred in 10% patients. 57% patients received observations at 4 hourly intervals throughout admission. Reassessment rates were low with 28% patient being reassessed within 20 minutes of their bronchodilator.
Results: 47/48 notes were available for analysis (female¼44, male¼3, mean age 11.3 years). 33 admissions were after deliberate OD while 14 were after accidental OD. 23% of admissions were unnecessary; the ODs were accidental and less than 75mg/kg. 9 patients were treated with N-acetylcysteine, 22% of these were treated inappropriately as the paracetamol level was sampled before accurate analysis was possible (<4 hours). Investigations recommended by Toxbase were inconsistently performed; venous bicarbonate and International Normalised Ratio (INR) were carried out just in 25.5% of cases.
Conclusions: This audit highlighted many of the guidelines were not being followed; therefore the following recommendations were made. Display and publish guidelines prominently. Highlight the importance of rapid review of asthmatic children. Re-audit in one year to reassess compliance.
PAEDIATRICS AND CHILD HEALTH 23:7
Conclusions: By Toxbase standards, some patients were admitted unnecessarily after accidental paracetamol overdose and there were instances in which N-acetylcysteine was prescribed inappropriately. Additionally, recommended biochemical investigations were frequently not performed. A
330
Ó 2013 Published by Elsevier Ltd.