Relationships between deprivation and duration of children's emergency admissions for breathing difficulty, feverish illness and diarrhoea in North West England: an analysis of hospital episode statistics

Implementation of the WHO standards to assess the quality of care for children with acute diarrhoea: findings of a multicentre study (CHOICE) in Italy

BACKGROUND

There is no documented experience in the use of the WHO standards for improving the quality of care (QOC) for children at the facility level. We describe the use of 10 prioritised WHO-Standard-based Quality Measures to assess QOC for children with acute diarrhoea (AD) in Italy.

METHODS

In a multicentre observational study in 11 paediatric emergency departments with different characteristics and geographical location, we collected data on 3061 children aged 6 months to 15 years with AD and no complications. Univariate and multivariate analyses were conducted.

RESULTS

Study findings highlighted both good practices and gaps in QoC, with major differences in QOC across facilities. Documentation of body weight and temperature varied from 7.7% to 98.5% and from 50% to 97.7%, respectively (p<0.001); antibiotic and probiotic prescription rates ranged from 0% to 10.1% and from 0% to 80.8%, respectively (p<0.001); hospitalisations rates ranged between 8.5% and 62.8% (p<0.001); written indications for reassessment were provided in 10.4%-90.2% of cases (p<0.001). When corrected for children's individual characteristics, the variable more consistently associated with each analysed outcome was the individual facility. Higher rates of antibiotics prescription (+7.6%, p=0.04) and hospitalisation (+52.9%, p<0.001) were observed for facilities in Southern Italy, compared with university centres (-36%, p<0.001), independently from children characteristics. Children's clinical characteristics in each centre were not associated with either hospitalisation or antibiotic prescription rates.

CONCLUSIONS

The 10 prioritised WHO-Standard-based Quality Measures allow a rapid assessment of QOC in children with AD. Action is needed to identify and implement sustainable and effective interventions to ensure high QOC for all children.

Child poverty and health inequalities in the UK: a guide for paediatricians

One in three children in the UK lives in relative poverty. There are clear and consistent links between child poverty and paediatric morbidity and mortality. In this review, we discuss drivers for family poverty in the UK, and how this leads to poor child health outcomes. We present a framework for healthcare professionals and institutions to consider interventions and strategies relating to socioeconomic health inequalities. We will focus on approaches to mitigate the effects of child poverty on children using our services at a local level and outline the importance of healthcare workers advocating for structural and high-level policy change to address the deep-rooted societal problems that cause child poverty.

Impact of social deprivation on length of stay for common infectious diseases in two French university-affiliated general pediatric departments

BACKGROUND

Adult deprived patients consume more healthcare resources than others, particularly in terms of increased length of stay (LOS) and costs. Very few pediatric studies have focused on LOS, although the effect of deprivation could be greater in children due to the vulnerability of this population. Our objective was to compare LOS between deprived and nondeprived children hospitalized for acute infectious diseases in two university-affiliated pediatric departments located in a low-income area of northern Paris.

METHODS

We performed a prospective observational multicenter study in two university-affiliated hospitals, Hôpital Robert-Debré and Hôpital Jean-Verdier. All the patients under 15 years of age admitted to the general pediatric department for pneumonia, bronchiolitis, gastroenteritis, or pyelonephritis between 20 October 2016 and 20 March 2017 were included. Deprivation was assessed with an individual questionnaire and score (EPICES). Endpoints included length of stay, costs, and readmission rates at 15 days in each quintile of deprivation. Multivariate regression assessed the association between deprivation and each endpoint.

RESULTS

A total of 556 patients were included in the study and 540 were analyzed. Sixty percent were boys and the mean age was 9 months±18. Bronchiolitis was the most frequent diagnosis (67.8%). Fifty-six percent of patients were considered to be deprived based on the EPICES questionnaire. Mean LOS was 4.6±3.5 days and we found no significant difference in LOS between the different deprivation quintiles (P=0.83). Multivariate regression did not show an association between LOS and deprivation.

CONCLUSION

There was no difference between deprived and nondeprived patients in terms of LOS. Deprivation may therefore impact hospitals in other ways such as admission rates. The impact of deprivation during hospitalization for chronic diseases should also be investigated.

Preschool children who are frequent attenders in emergency departments: an observational study of associated demographics and clinical characteristics

BACKGROUND

Unscheduled visits to emergency departments (ED) have increased in the UK in recent years. Children who are repeat attenders are relatively understudied.

AIMS

To describe the sociodemographic and clinical characteristics of preschoolers who attend ED a large District General Hospital.

METHOD/STUDY DESIGN

Observational study analysing routinely collected ED operational data. Children attending four or more visits per year were considered as 'frequent attenders'. Poisson regression was used with demographic details (age, sex, ethnicity, sociodemographic status) to predict number of attendances seen in the year. We further analysed detailed diagnostic characteristics of a random sample of 10% of attendees.

MAIN FINDINGS

10 169 patients visited in the 12-month period with 16 603 attendances. 655 individuals attended on 3335 occasions. 6.4% of this population accounted for 20.1% of total visits. In the 10% sample, there were 304 attendances, and 69 (23%) had an underlying chronic long-standing illness (CLSI). This group were 2.4 times more likely to be admitted as inpatients compared with those without such conditions, median length of stay of 6.2 hours versus 2.5 hours (p=NS).

CONCLUSIONS

Frequent ED attenders fall broadly into two distinct clinical groups: those who habitually return with self-limiting conditions and those with or without exacerbation of underlying CLSI. Both groups may be amenable to both additional nursing and other forms of community support to enhance self-care and continuity of care. Further research is required to increase our understanding of specific individual family and health system factors that predict repeat attendance in this age group.

Length of paediatric inpatient stay, socio-economic status and hospital configuration: a retrospective cohort study

BACKGROUND

Variation in paediatric inpatient length of stay exists - whether this is driven by differences in patient characteristics or health service delivery is unclear. We will test the hypotheses that higher levels of deprivation are associated with prolonged length of stay and that differences in prolonged length of stay across 2 hospitals will be explained by demographic, clinical and process factors.

METHODS

This is a retrospective cohort study of 2889 children aged less than 16 years admitted from 1st April 2009 to 30^th March 2010. Administrative data were used from two UK hospitals whose Accident and Emergency (A&E) departments were paediatric and adult physician led respectively. The main outcome was prolonged length of stay defined as greater than or equal to the mean (1.8 days). Sensitivity analyses defined prolonged length of stay as greater than the median (1 day). Demographic, clinical and process characteristics were examined. Socio-economic position was measured by Income Deprivation Affecting Children Index. Multivariable logistic and linear regression analyses were performed.

RESULTS

We did not find a consistent association between length of stay and socio-economic position, using a variety of definitions of length of stay. In contrast, adjusted for age, gender, socio-economic position, ethnicity, final diagnosis, number of hospital admissions, source of admission, and timing of admission, admission to the adult led A&E hospital was more strongly associated with prolonged length of stay (Odds Ratio 1.41, 95% Confidence Interval 1.16, 1.71).

CONCLUSION

Local variation in paediatric inpatient length of stay was not explained by demographic, clinical or process factors, but could have been due to residual confounding by medical complexity. Length of stay was not consistently associated with socio-economic position suggesting that length of stay is a function of health service not the determinants of health. Analyses of these types of data would be strengthened by measures of complexity and adverse events.