Who comes back with what: a retrospective database study on reasons for emergency readmission to hospital in children and young people in England

Wijlaars, L.P.M.M. et al. Archives of Disease in Childhood.  Published Online: 25 April 2016

10998-2Objective: To determine the proportion of children and young people (CYP) in England who are readmitted for the same condition.

Design: Retrospective cohort study.

Setting: National administrative hospital data (Hospital Episode Statistics).

Participants: CYP (0-year-olds to 24-year-olds) discharged after an emergency admission to the National Health Service in England in 2009/2010.

Main outcome measures: Coded primary diagnosis classified in six broad groups indicating reason for admission (infection, chronic condition, injury, perinatal related or pregnancy related, sign or symptom or other). We grouped readmissions as ≤30 days or between 31 days and 2 years after the index discharge. We used multivariable logistic regression to determine factors at the index admission that were predictive of readmission within 30 days.

Results: 9% of CYP were readmitted within 30 days. Half of the 30-day readmissions and 40% of the recurrent admissions between 30 days and 2 years had the same primary diagnosis group as the original admission. These proportions were consistent across age, sex and diagnostic groups, except for infants and young women with pregnancy-related problems (15–24 years) who were more likely to be readmitted for the same primary diagnostic group. CYP with underlying chronic conditions were readmitted within 30 days twice as often (OR: 1.93, 95% CI 1.89 to 1.99) compared with CYP without chronic conditions.

Conclusions: Financial penalties for readmission are expected to incentivise more effective care of the original problem, thereby avoiding readmission. Our findings, that half of children come back with different problems, do not support this presumption.

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Hypoallergenic formula and eczema

 Archives of Disease in Childhood. 2016. 101 504

Image source: Alicia Voorhies // CC BY-ND 2.0

Parents who are atopic often ask us how they can prevent troublesome symptoms, particularly eczema, in their babies. We would, of course, recommend exclusive breastfeeding, but if mothers choose to wean off the breast for any reason, what formula should we recommend? Some preliminary evidence suggests that hypoallergenic formula, with oligosaccharide prebiotic supplementation, might be beneficial.

A study funded by a formula-manufacturing company set out to investigate this, clearly with an eye to producing a formula aimed at these babies (PATCH study; Boyle R, et al. Allergy 2016. doi:10.1111/all.12848). They randomised 860 infants with a family history of allergic disease to receive either the intervention feed, a partially-hydrolysed whey formula with oligosaccharides, or a control standard formula, if the mothers chose to introduce formula before 18 weeks. Ten centres in Australia, Singapore, England and Ireland were involved.

They found no difference in the primary outcome, eczema prevalence, between the groups at 12 months (29% in both) or at 18 months. IgE levels, both total and cow’s milk specific, also did not differ. There were some differences in specific Ig1 and T-cell values which might suggest long-term protection.

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Pain assessment in children

Anaesthesia & Intensive Care Medicine

Acute pain in children can occur following trauma and injury or secondary to medical and surgical intervention. Before acute pain can be effectively treated, it must be accurately assessed. In spite of many years of research to enhance our understanding of pain, the assessment of pain in children continues to be a challenge and is often inconsistent and suboptimal in many organizations.

B0009782 Losartan and Lidocaine
image shows micrograph of Losartan and Lidocaine. source: Lars Bech, Wellcome Images//CC BY-NC-ND 4.0

Pain and its perception are multi-factorial, hence an approach to pain assessment and treatment must also be multi-faceted and multidisciplinary. Painful experiences are dynamic, with huge inter- and intra-individual variation; therefore pain assessment tools must be adaptable, reproducible and accurate to accommodate such variation.

This article outlines the different tools available for pain assessment in infants and children.

Brand, K. & Thorpe, B. Pain assessment in children Anaesthesia & Intensive Care Medicine. Available online 20 April 2016.

Perinatal and infant mental health

Guidance highlights the role of Specialist Health Visitors in Perinatal and Infant Mental Health

  Image source: http://www.hee.nhs.uk/

Health Education England has published Specialist Health Visitors in Perinatal and Infant Mental Health – What they do and why they matter.  This guidance concludes that all women and their partners should have access within their local health visiting service to a specialist health visitor in perinatal and infant mental health.  According to the National Institute for Health and Care Excellence (NICE), more than one-in-ten women will experience mental health problems during pregnancy and after the child’s birth, which means that some 70,000 families could be affected by mental health issues.

Managing Pain in Children: Helping to Improve the Use of Evidence in Practice

Twycross, A. BMJ Evidence-based Nursing Blog. Published online: 18 April 2016

By Alison Twycross (@alitwy), Head of Department for Children’s Nursing and Professor of Children’s Nursing, London South Bank University.

Image source: Robert Weis // CC BY-SA 4.0

I have been editor of Evidence Based Nursing since August 2010 and during that time I have worked with a team of associate editors to make the evidence to guide practice more accessible to nurses working in clinical practice. Alongside this I have also carried out research relating to managing pain in children. My current research focuses on the management of acute, post-operative and cancer-related pain in children and in particular on supporting parents to manage their child’s pain at home. I have also edited three books pulling together the evidence for managing pain in children. Details of the 2014 book can be found at: http://eu.wiley.com/WileyCDA/WileyTitle/productCd-0470670541.html

The observational studies demonstrate that current practices confirm to clinical guidelines in some but not all areas and we still have:

  • Inconsistent pain assessment practices – for example, not all children have pain scores recorded
  • Pain management is seen by many nurses as synonymous with administering analgesic drugs
  • Decision-making about which pain relieving interventions to use is not guided by pain scores
  • Non-drug methods are not seen as a nursing role – instead they are seen as a parents’ role or something for the play specialist
  • Limited communication with child and parents about pain management
  • Limited documentation about pain management
  • Children experiencing moderate to severe pain unrelieved pain during a hospital stay

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‘Risk of death’ warning over access to Caesareans

A senior coroner has warned of a risk of future deaths if the NHS favours vaginal delivery over Caesarean sections on the basis of cost. Andrew Walker wants action taken after an inquest into the death of a newborn.

Kristian Jaworski died five days after his birth in June 2015 as a result of brain damage during a “prolonged and extended instrumental delivery”. North Middlesex University Hospital has accepted liability for his death, but said cost had not been a consideration. Mr Walker’s report, sent to the Department of Health, says that in the case of Kristian Jaworski there appeared to be a financial reason for favouring a vaginal delivery “that needed to be rebutted”.

The coroner described how Tracey Taylor, Kristian’s mother, repeatedly told medical staff that she needed a Caesarean after complications during the birth of her first child Sebastian, three and a half years earlier. But the information was never recorded in her medical notes and she said her requests for a Caesarean during a lengthy and difficult labour were ignored. The inquest heard that doctors tried repeatedly to deliver Kristian in theatre using suction and then forceps, before performing an emergency Caesarean under general anaesthetic.

Read the full news story here