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A study of paediatric and adolescent gynaecology services in a British district general hospital
1Department of Obstetrics and Gynaecology, Kettering General Hospital, Kettering, NN16 8UZ, UK. smcgreal@doctors.org.uk
Insights
A Paediatric and Adolescent Gynaecology (PAG) service provides essential care for children with gynaecological issues. This review highlights the service
Area of Science:
- Paediatric Gynaecology
- Adolescent Gynaecology
- Healthcare Services Research
Background:
- National guidelines recommend specialized paediatric care for children's gynaecological needs.
- District general hospitals require dedicated services to address these specific patient demographics.
- The Paediatric and Adolescent Gynaecology (PAG) service at Kettering General Hospital was established to meet these requirements.
Purpose of the Study:
- To review the role and effectiveness of a Paediatric and Adolescent Gynaecology (PAG) service within a British district general hospital setting.
- To analyze patient demographics, common presentations, and management outcomes.
- To assess the impact of the PAG service on patient care pathways and best practice.
Main Methods:
- A 15-year retrospective review of patients attending the PAG clinic (1994-2009).
- Inclusion of 800 patients from a UK district general hospital's outpatient and inpatient services.
- Individual medical record review to extract data on demographics, referrals, symptoms, diagnoses, management, and outcomes.
Main Results:
- The majority of patients (86%) were referred from primary care.
- Common presentations included vulvovaginitis (18%), labial adhesions (14%), abdominal pain (7%), and precocious puberty (6%).
- Fifteen percent of patients required admission, primarily for procedures like vaginoscopy.
Conclusions:
- The PAG service has established crucial care pathways and fostered 'best practice' for paediatric and adolescent gynaecological patients.
- The development of similar services across the UK is advocated by the British Society for Paediatric and Adolescent Gynaecology.
- Healthcare policymakers and trusts should promote and support the establishment of these specialized services.
Objective:
The Paediatric and Adolescent Gynaecology service (PAG) at Kettering General Hospital is a designated service meeting the needs of children with gynaecological problems. National guidelines reinforce the fact that children should be seen within specific paediatric areas in hospital. We aim to review the role of such a service in the context of a British district general hospital.
Design:
Retrospective review spanning 15 years.
Setting:
The outpatient/inpatient service of a UK district general hospital.
Population:
A total of 800 patients were included in the study.
Methods:
We identified patients attending the PAG clinic between 1994 and 2009. Medical notes were reviewed individually.
Main Outcome Measures:
Demographics, referral source, presenting symptoms, examination findings, diagnosis, management, admissions and referrals to tertiary centres.
Results:
In total, 86% of patients were referred from primary care. The age distribution was bimodal at 4 and 15 years of age: the average age was 10 years. Sixty percent of patients were followed-up, giving a total of 2023 appointments. The commonest presentations were vulvovaginitis (18%), labial adhesions (14%), abdominal pain (7%) and precocious puberty (6%). A total of 15% of patients were admitted, largely for planned procedures, of which vaginoscopy was the most frequent.
Conclusions:
The PAG service has enabled pathways for care that were previously non-existent, as well as the development of 'best practice'. The British Society for Paediatric and Adolescent Gynaecology has been seeking to develop a network of similar services at secondary and tertiary level throughout the UK. This approach should be encouraged and promoted by those in charge of healthcare policy and provider trusts in general.
