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ObjectiveChildhood burns represent a burden on health services, yet the full extent of the problem is difficult to quantify. We estimated the annual UK incidence from primary care (PC), emergency attendances (EA), hospital admissions (HA) and deaths.MethodsThe population was children (0–15 years), across England, Wales, Scotland and Northern Ireland (NI), with medically attended burns 2013–2015. Routinely collected data sources included PC attendances from Clinical Practice Research Datalink 2013–2015), EAs from Paediatric Emergency Research in the United Kingdom and Ireland (PERUKI, 2014) and National Health Services Wales Informatics Services, HAs from Hospital Episode Statistics, National Services Scotland and Social Services and Public Safety (2014), and mortality from the Office for National Statistics, National Records of Scotland and NI Statistics and Research Agency 2013–2015. The population denominators were based on Office for National Statistics mid-year population estimates.ResultsThe annual PC burns attendance was 16.1/10 000 persons at risk (95% CI 15.6 to 16.6); EAs were 35.1/10 000 persons at risk (95% CI 34.7 to 35.5) in England and 28.9 (95% CI 27.5 to 30.3) in Wales. HAs ranged from 6.0/10 000 person at risk (95% CI 5.9 to 6.2) in England to 3.1 in Wales and Scotland (95% CI 2.7 to 3.8 and 2.7 to 3.5, respectively) and 2.8 (95% CI 2.4 to 3.4) in NI. In England, Wales and Scotland, 75% of HAs were aged <5 years. Mortality was low with 0.1/1 000 000 persons at risk (95% CI 0.06 to 0.2).ConclusionsWith an estimated 19 574 PC attendances, 37 703 EAs (England and Wales only), 6639 HAs and 1–6 childhood deaths annually, there is an urgent need to improve UK childhood burns prevention.

Background:The recognition of possible non-accidental injury (NAI) in children is an area of ongoing concern for all emergency departments. Limb fractures in non-mobile children should alert clinicians to consider NAI and refer the child for further management. A study was undertaken of the management of such children in a paediatric emergency department (PED) to identify the age and sex of such infants, their mechanism of injury, documentation of developmental milestones, the type of fracture sustained, the number of previous attendances and evidence of referral for senior review and referral to the social services (where appropriate).Method:The study was conducted in a large PED which currently sees over 30 000 children per year. A retrospective review was carried out of the notes of all children under 1 year of age presenting with a limb fracture over a 4.5-year period. Patients were identified by their discharge diagnosis on the computerised emergency department (ED) system.Results:20 497 children under the age of 1 year presented to the ED during the study period. 244 of these presented with limb injuries, of which 39 had fractures. Of these, 36 sets of notes were analysed; 14 of the children were referred for senior review, 10 of whom were thought to be possible NAI and were admitted for further management (median age 23.5 weeks (range 6–48)). This left 22 children under 1 year of age who were seen and managed solely by a PED senior house officer (median age 43 weeks (range 26–51)). In the opinion of the reviewing clinicians, six of these cases may have benefited from senior review.Conclusion:Limb fractures in non-mobile children account for a small proportion of PED attendances. There needs to be increased awareness of the potential for NAI in this population. Documentation and understanding of developmental history must be emphasised to show that this has been considered in relation to NAI. Children under 1 year of age are particularly vulnerable and, when they present with a limb fracture, they must be discussed with a senior paediatrician. The changes made locally are discussed and a suggested flow chart provided for possible use in other departments.

Aims and objectivesRecently published evidence suggests a large proportion of children presenting to Paediatric Emergency Departments (EDs) could be managed in proposed out of hospital models of care (OOHMs) described by NHS England’s Five Year Forward View (FYFV).The main aim of this study was to assess whether or not families would choose the new OOHMs instead of the current ED and explore the reasons behind these attitudes. The study secondly aimed to identify motivators of attendance to Paediatric A and E.MethodsThis study was qualitative in design. Ethical approval was obtained and data collected over a one-week period using an electronic anonymous patient questionnaire (response rate 72%). Ninety responses were evenly distributed across the days of the week between the hours of 10am and 10pm; the likely opening hours of the proposed OOHMs. The questionnaire was composed of open and closed questions derived from the FYFV’s description of the OOHMs and previously published motivators of attendance to the ED in adults. Thematic analysis was used to identify themes in free text responses and mean Likert scale responses were calculated for closed questions.ResultsThe proposed OOHMs were generally well received, except for assessment utilising digital technology. Mean Likert scale responses to descriptions of each aspect nearly all demonstrated agreement or tended towards strong agreement that study participants would like to use each of the proposed models if put in place locally. The most supported aspect was the introduction of a GP Paediatrician service (mean Likert response 4.34 out of 5). Motivators of attendance largely mirrored those seen in adults, though thematic analysis suggested patients would like to attend their GP rather than ED provided they could access appointments and had confidence in their practitioner’s access to Paediatric support and ability to assess their child.ConclusionsIn conclusion the study participants’ responses reflected a willingness to access the proposed OOHMs particularly the concept of specialist GP Paediatricians. This evidence can be used to support future planning of services to provide cost effective, optimal patient care. It is also imperative that the identified recurring motivators of attendance to ED are addressed.

AimBlood pressure (BP) is not measured routinely in children at triage, but should be done in a selective group of children. In our busy Children’s ED we have developed a local guideline in response to critical incidents where BP was not found to have been measured. We report a retrospective audit on how successfully we followed our local policy and performed BP measurement in population of children.MethodsWe performed a retrospective audit looking at the ED notes over the month of March, 2015 of all children fulfilling the criteria of our guideline who should have had a BP measurement performed at triage. We reviewed the following data: adherence to the guideline compared to the age of the child and indication for the BP measurement.A literature search was also performed to look at data from other hospitals and for any guideline available.Results107 records were reviewed where the patient qualified for a BP measurement according to the guideline. Only 46% had a BP measured. 5% of the children were <1 year old, 42% were 1–5 years old, (in total 47% were children under five where BP measurement can be difficult). A detailed breakdown of the patients according to the clinical indication is shown in Figure 1.Abstract G254(P) Figure 1ConclusionBlood pressure is not performed as a screening tool in the Children’s ED as measuring blood pressure in children can be problematic. An appropriately sized cuff may not be available, the child could be non co-operative and the readings could be falsely high. In most EDs, clear guidance is unavailable for absolute indication of measuring BP in children.We have shown that despite the development of clear guidance on whom to measure BP we only achieve this in less than 50% of cases. This is in a busy children’s ED with fully trained children’s nurses.Measurement of BP is essential in a group of children either as a baseline or as a guide to their care. We therefore recommend that BP should be measured whenever possible in children’s A&E particularly with the presentations mentioned in our guideline.

Objectives & BackgroundThe Children's Emergency Department at University Hospital Lewisham sees up to 130 attendances daily. This can result in delays to triage and sick children being missed.In our department, 50–84% of children are triaged within 15 minutes (monthly variation). Peak median time to triage is 41 mins and can depend on skill mix.Our objective was to create a safe Rapid Triage Tool to assess patients rapidly and identify the most unwell patients early. Recent RCEM work on Vital Signs in Children Clinical Audit 2015–16 indicated the need for improvement. Our project supports standards 1 and 3. It can also help to meet the KPI for initial assessment of ambulance patients and the RCEM pain targets.MethodsRapid Assessment Tools were designed by extrapolating from the Manchester Triage System. One for trauma/injury and a second for medical illness figures 1 and 2.▸ Pilot of 40 patients triaged- weekdays, evenings, weekends and night shifts▸ Rapid Assessment was employed when the wait for triage was greater than 30 minutes and there were more than 3 patients waiting. It was done in one minute by a senior nurse with relevant training▸ The nurse assesses the patient using the proforma, assigns a priority and indicates what actions are required▸ Secondary nurse then acts on these and completes the triage- Figure 3.Results40 patients were assessed using the Rapid Assessment Tool.▸ Qualitative correlation to the traditional triage was made and the patients were shown to be given the same priority ranking in all cases▸ It takes less than a minute to perform the Rapid Assessment compared to 5–20 minutes for the traditional triage.▸ Flow through the initial stages in the department was quicker▸ There was better use of the nursing skill mix▸ The sickest patients were identified faster▸ Figure 4ConclusionThis Rapid Triage Tool may be a safe tool to use in replacement of the traditional triage method. The perception from staff was that this felt safer and reduced the workload when there was large volume of patients.Further work▸ Training is required to standardise the implementation of the Rapid Triage Tool▸ A larger pilot will be conducted to make quantitative conclusions about the effects this has on overall triage time, time to treatment and the on meeting the RCEM Vital Signs and Pain Standards and the KPI▸ This project has identified a number of areas for improvement such as an extra HCA at triage to facilitate the observations and providing all staff with mobile saturation probesFigure 1Rapid Assessment Proforma for Illness.Figure 2Rapid Assessment Proforma for Injury.Figure 3Results (Outcomes).

OBJECTIVE To assess the value of sequential lactate measurement in predicting postoperative mortality after surgery for complex congenital heart disease in children. DESIGN Prospective observational study. SETTING Sixteen bedded paediatric intensive care unit (PICU). SUBJECTS Ninety nine children ( 90 survivors, nine non-survivors). MEASUREMENTS Serum lactate and base deficit were measured on admission and every six hours thereafter. Data were analysed by Mann-Whitney and Fisher’s exact tests. RESULTS There was considerable overlap in initial lactate values between the survivor and non-survivor groups. Initial lactate was significantly raised in non-survivors (median 8.7, range 1.9–17.6 mmol/l) compared with survivors (median 2.4, range 0.6–13.6 mmol/l) (p = 0.0002). Twenty one patients (21.1%) with initial lactate concentrations greater than 4.5 mmol/l survived to PICU discharge. Using receiver operating characteristic analysis an initial lactate of 6 mmol/l had the optimum predictive value for mortality. Initial postoperative serum lactate >6 mmol/l predicted mortality with sensitivity 78%, specificity 83%, and positive predictive value of only 32%. CONCLUSION Initial lactate concentrations have poor positive predictive value for mortality. The routine measurement of lactate for this purpose cannot be justified in clinical practice.

Objectives To establish the safety of an intranasal diamorphine (IND) spray in children. Design An open-label, single-dose pharmacovigilance trial. Setting Emergency departments in eight UK hospitals. Participants Children aged 2–16 years with a fracture or other trauma. Outcome measures Adverse events (AE) specifically related to nasal irritation, respiratory and central nervous system depression. Results 226 patients received 0.1 mg/kg IND. No serious or severe AEs occurred. The incidence of treatment-emergent AEs (TEAEs) was 26.5% (95% CI 20.9% to 32.8%), 93% being mild. 89% were related to treatment, all being known effects of the drug or route of administration except for three events in two patients. 20.4% (95% CI 15.3% to 26.2%) patients reported nasal irritation, all mild except one moderate and one ‘unknown’ severity. No respiratory depression was reported. Three AEs related to reduced Glasgow Coma Score (GCS) occurred, all mild. Conclusions There were no safety concerns raised during the conduct of the study. In addition to expected side effects, IND can cause mild nasal irritation in a proportion of patients. European Union Drug Regulating Authorities Clinical Trial No 2009-014982-16.

Comparison of data by calendar month (for example, January 1993 compared with January 1994) showed that the median number of patient episodes per month increased after the introduction of the service (20.0 v 35.5, P<0.0001), as did the median number of bed days per month (83.0 v 177.5, P<0.001, Mann-Whitney U test).

[...]it is questionable whether they had discovered all the bacteraemias. The abstract they refer to presented at the RCPCH meeting last year 4-1 states that the presence of poor capillary refill, meningism, altered conscious level, or tachypnoea identified 28 of 32 children with culture proven meningococcal disease. 3 of the 4 children not identified had a maculopapular rash (ie not petechial?). [...]12 of 32 children with meningococcal disease had total WCC greater than 15, but we are not told if any of the \"missed\" cases had abnormal total white cell count, or elevation of serum C reactive protein.