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What do we really know about infants who attend Accident and Emergency departments?
Michelle Heys1, Ho-Ming Kwong, Jo Reed
1UCL Institute for Global Health, London, UK and Child Public Health Group, Imperial College River Island Academic Department, Paediatric Department, Northwick Park Hospital (NWLH NHS Trust), London, UK.
Insights
Infant attendances at Accident and Emergency (A&E) departments are high. Many infants lack clear diagnoses, suggesting a need for better coding and alternative care pathways for those without medical issues.
Area of Science:
- Pediatrics
- Emergency Medicine
- Health Services Research
Background:
- Accident and Emergency (A&E) attendances are increasing, with infants disproportionately represented.
- Understanding the clinical reasons for infant A&E visits is crucial for resource allocation and service planning.
Purpose of the Study:
- To examine the clinical reasons for infant attendance at UK Accident and Emergency departments.
- To assess the accuracy of diagnostic coding for infant A&E visits.
Main Methods:
- Retrospective review of 6,667 infants (<1 year) attending A&E in London hospitals (April 2009-March 2010).
- Analysis of diagnostic categories assigned by medical coders.
- Detailed audit of case notes for a 10% subsample (n=535) from top diagnostic categories.
Main Results:
- Top diagnoses included infectious diseases, gastrointestinal, respiratory, unclassifiable, and no abnormality detected (NAD).
- Initially, 33% of infants were diagnosed as unclassifiable or NAD.
- Detailed review reduced unclassifiable diagnoses to 9.7% and NAD to 8.8%.
Conclusions:
- Accurate clinical diagnosis and coding are vital for effective health service evaluation, planning, and research.
- A significant proportion of infants (approx. 10%) attend A&E with no clear medical abnormality.
- Alternative service provision and parental support may better address the needs of infants attending A&E without underlying medical issues.
Aims:
Accident and Emergency attendances continue to rise. Infants are disproportionately represented. This study examines the clinical reasons infants attend UK Accident and Emergency departments.
Methods:
A retrospective review of 6,667 infants aged less than one year attending Accident and Emergency at two district general hospitals in London from 1(st) April 2009 to 30(th) March 2010. All infants had been assigned to a diagnostic category by the medical coding department according to National Health Service (NHS) data guidelines, based on the clinical diagnoses stated in the medical records. The Accident and Emergency case notes of a random subsample of 10% of infants in each of the top five recorded diagnostic categories (n = 535) were reviewed in detail and audited against the standard national NHS data set.
Results:
The top 5 clinical diagnoses were 'infectious diseases', 'gastrointestinal', 'respiratory', 'unclassifiable' and 'no abnormality detected' (NAD). A third of infants were originally given a diagnosis of unclassifiable (21.5%) or NAD (11.5%). After detailed case-note review, we were able to reduce this to 9.7% (95% confidence interval (CI): 9.0, 10.4) and 8.8% (95% CI: 8.1, 9.5), respectively.
Conclusion:
This study demonstrates the importance of providing a clear clinical diagnosis and coding system for Accident and Emergency attendances and understanding that system fully. This would allow for better informed health service evaluation, planning and research as each of these relies on the interpretation of routine health-care data. Furthermore, the relatively high proportion (10%) of infants attending with no discernible underlying medical abnormality suggests the health needs of a significant proportion of infants attending Accident and Emergency departments may be better addressed by alternative service provision and/or improved education and support to parents.
