Lower Risk of Multisystem Inflammatory Syndrome in Children With the Delta and Omicron Variants of Severe Acute Respiratory Syndrome Coronavirus 2.

Little is known about the risk of multisystem inflammatory syndrome in children (MIS-C) with different severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants. In southeast England, MIS-C rates per confirmed SARS-CoV-2 infections in children aged 0-16 years were 56% lower (rate ratio [RR], 0.34 [95% confidence interval {CI}, .23-.50]) during prevaccine Delta, 66% lower (RR, 0.44 [95% CI, .28-.69]) during postvaccine Delta, and 95% lower (RR, 0.05 [95% CI, .02-.10]) during the Omicron period.

Developing new models of care at speed: learning from healthcare redesign for children with COVID-related multisystem inflammation.

This article describes the rapid, system-wide reconfiguration of local and network services in response to the newly described paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) (also known as multisystem inflammatory syndrome in children). Developing the model of care for this novel disease, whose natural history, characteristics and treatment options were still unclear, presented distinct challenges.We analyse this redesign through the lens of healthcare management science, and outline transferable principles which may be of specific and urgent relevance for paediatricians yet to experience the full impact of the COVID-19 pandemic; and more generally, for those developing a new clinical service or healthcare operating model to manage the sudden emergence of any unanticipated clinical entity. Health service leaders in areas where COVID-19 is, or will soon be, in the ascendancy, and who are anticipating the imminent influx of PIMS-TS, should use these principles and recommendations to plan an agile, responsive and system-wide model of care for these children.

Public health for paediatricians: Fifteen-minute consultation on addressing child poverty in clinical practice.

Paediatricians and other child health professionals have a key role in identifying, preventing or mitigating the impacts of poverty on child health. Approaching a problem as vast and intractable as poverty can seem daunting. This article will outline how social determinants impact child health, and provide practical guidance on how to address this problem through a public health lens. The aim is to give frontline practitioners a straightforward, evidence-based framework and practical solutions for tackling child poverty, across three levels: (1) the clinical consultation; (2) the clinical service for the population of children and young people we serve and (3) with a broader policy and social view.

Use of age-specific hospital catchment populations to investigate geographical variation in inpatient admissions for children and young people in England: retrospective, cross-sectional study.

OBJECTIVES: To develop a method for calculating age-specific hospital catchment populations (HCPs) for children and young people (CYP) in England. To show how these methods allow geographical variation in hospital activity to be investigated and addressed more effectively. DESIGN: Retrospective, secondary analysis of existing national datasets. SETTING: Inpatient care of CYP (0-18 years) in England. PARTICIPANTS: Hospital Episode Statistics (HES) data were accessed for all inpatient admissions (elective and emergency) for CYP from birth to 18 years, 364 days, for 2011/2012-2014/2015. In 2014/2015, 857 112 admissions were analysed, from an eligible population of approximately 11.9 million CYP. OUTCOME MEASURES: For each hospital Trust, the catchment population of CYP was calculated; Trust-level admission rates per thousand per year were then calculated for admissions due to (1) any diagnostic code, (2) primary diagnosis of epilepsy and (3) epilepsy listed as primary diagnosis or comorbidity. RESULTS: Estimated 2014/2015 HCPs for CYP ranged from 268 558 for Barts Health NHS Trust to around 30 000 for the smallest acute general paediatric services and below 10 000 for many Trusts providing specialist services. As expected, the composition of HCPs was fairly consistent for age breakdown but levels of deprivation varied widely. After standardising for population characteristics, admission rates with a primary diagnosis of epilepsy ranged from 14.3 to 157.7 per 100 000 per year (11.0-fold variation) for Trusts providing acute general paediatric services. All-cause admission rates showed less variation, ranging from 4033 to 11 681 per 100 000 per year (2.9-fold variation). CONCLUSIONS: Use of age-specific catchment populations allows variation in hospital activity to be linked to specific teams and care pathways. This provides an evidence base for initiatives to tackle unwarranted variation in healthcare activity and health outcomes.

Change in viral bronchiolitis management in primary care in the UK after the publication of NICE guideline.

The aim of this study was to investigate changes in general practitioner (GP) management before and after the publication of the National Institute for Health and Care Excellence bronchiolitis guideline. In March 2015 and May 2016, an electronic questionnaire was sent to GPs. It was completed by 1001 GPs in 2015 and 1009 in 2016. There were small but significant improvements in proportions of GPs using a guideline, measuring oxygen saturations and providing written guidance, and appropriate reductions in those prescribing medications. Thirty-five per cent had read the guideline and 25% changed their practice since guideline publication. There were modest but significant improvements in reported management by GPs after guideline publication.

Does increased duration of consultant presence affect length of hospital stay for unplanned admissions in acute paediatrics?: an observational before-and-after analysis using administrative healthcare data.

OBJECTIVES: This study aims to review whether implementation of increased duration of consultant presence is associated with reduction in length of hospital stay (LoS) in children with an unplanned admission to hospital. METHOD DESIGN/SETTING/PARTICIPANTS/INTERVENTIONS/OUTCOME MEASURES: An observational before-and-after study of all unplanned general paediatric admissions to a UK hospital between 1 September 2012 and 31 August 2015, comparing LoS and readmission rates before and after implementation of a policy mandating consultant review within 12 hours of unplanned hospital admission. RESULTS: 5367 inpatient admissions were analysed: 3386 prior to implementation of the policy and 1981 afterwards. There was no significant difference in median LoS between the two groups or in readmission rates at 24 hours, 48 hours or 7 days. However, among children who stayed in hospital for under 24 hours, and those who were discharged with a diagnosis of acute gastroenteritis, consultant review within 12 hours of admission was associated with a shorter LoS-respectively, 16 hours 23 min versus 15 hours 45 min (p=0.01) and 28 hours 46 min versus 19 hours 41 m (p<0.01). CONCLUSIONS: Increased duration of consultant presence was not associated with significant impact on LoS, other than in admissions of brief duration and in gastroenteritis, where diagnosis is based on clinical judgement in the absence of objective diagnostic thresholds. Future studies should focus on whether these results are generalisable across other settings, and other measures of cost-effectiveness of early consultant review, given the major implications on resource and workforce planning of such policies.

The role of paediatricians in public health for children and young people.

There is an increasing awareness among practising clinicians that public health for children and young people has an enormous impact on child health outcomes, and is an intrinsic aspect of the practice of paediatrics. This article, the first in a series, explores the key concepts of child public health, explains why public health matters to clinicians through a series of examples, and outlines opportunities and resources for further learning.

The accuracy of existing prehospital triage tools for injured children in England: an analysis using emergency department data.

OBJECTIVE: To investigate the performance characteristics in children with moderate and minor injuries of prehospital paediatric triage tools currently in use in England for identifying seriously injured children. METHODS: Eight prehospital paediatric triage tools were identified from literature review and a survey of the lead trauma clinicians across the 10 English strategic health authorities. Retrospective clinical data from 2934 patient records collected by four emergency departments were used to analyse each tool. A target sensitivity of >95% and specificity of 50-75% was set based on the literature. RESULTS: Three tools (East Midlands, North West and Northern) demonstrated acceptable sensitivity (all 100%). The other five tools fell below the target sensitivity of >95%. All eight tools had acceptable specificity (with results between 79% and 99%). CONCLUSIONS: Three tools (East Midlands, North West and Northern) demonstrated acceptable over- and under-triage rates in this population of minor and moderately injured children. All tools reached recommended standards for over-triage, but the majority favoured under-triage.

Health policy research: successes and challenges.

This review seeks to explore and explain what health policy research is and why it matters, through pooling the evidence and providing case examples. Alongside examining the types of research involved, and their rationale the paper identifies the challenges taking part in this sort of research may create. Finally the paper suggests how to make clinical research more accessible to policy makers.

Using data to improve care.

We look at the role of data in improving the quality of care for children and young people: how they can help to identify a problem; guide design of solutions; and evaluate changes in practice. We introduce some principles for measurement in the field of quality improvement, and discuss how to use and present data to maximise their value and impact in quality improvement initiatives.

Unwarranted variation in health care for children and young people.

The study of geographical variation in healthcare has moved on since J Allison Glover's seminal study in 1938, and its value in highlighting inequity in access, quality and outcomes is well-established. Study of variation in healthcare for children, however, has proven more difficult due to barriers with data and idiosyncrasies in how we measure outcomes for children and families. This paper is a narrative review of unwarranted variations in healthcare for children, and discusses the potential of variation analysis to help researchers and policy makers improve child health services.

Population variation in admission rates and duration of inpatient stay for bronchiolitis in England.

AIM: To explore the variation in hospital admission rates and duration of inpatient stay across England. METHODS: Hospital Episode Statistics were used to identify all children aged below 2 years who were discharged from hospital with a primary code of bronchiolitis in England, between 1 April 2007 and 31 March 2010; rates of admission and duration of stay were analysed by Primary Care Trust (PCT). RESULTS: There were a total of 75 318 admissions for bronchiolitis in England in children under 2 years old during the study period. There was a 15-fold variation across PCTs in England in the admission rate for bronchiolitis (351-5140 admissions per 100 000; coefficient of variation (CV)=0.43) and a sixfold variation in the mean duration of stay in days for children with bronchiolitis (0.7-4.1 days in hospital; CV=0.27). Duration of stay was not correlated with socioeconomic deprivation, while admission rates showed variation even among PCTs of similar socioeconomic profile. CONCLUSIONS: We postulate that healthcare provider factors manifested by variation in clinical decision-making (including thresholds for admission and discharge, and variation in therapies) are responsible at least in part for variation in rate of admission and length of stay for children with bronchiolitis in England.

ECLIPPx: an innovative model for reflective portfolios in life-long learning.

BACKGROUND: For healthcare professionals, the educational portfolio is the most widely used component of lifelong learning - a vital aspect of modern medical practice. When used effectively, portfolios provide evidence of continuous learning and promote reflective practice. But traditional portfolio models are in danger of becoming outmoded, in the face of changing expectations of healthcare provider competences today. CONTEXT: Portfolios in health care have generally focused on competencies in clinical skills. However, many other domains of professional development, such as professionalism and leadership skills, are increasingly important for doctors and health care professionals, and must be addressed in amassing evidence for training and revalidation. There is a need for modern health care learning portfolios to reflect this sea change. INNOVATION: A new model for categorising the health care portfolios of professionals is proposed. The ECLIPPx model is based on personal practice, and divides the evidence of ongoing professional learning into four categories: educational development; clinical practice; leadership, innovation and professionalism; and personal experience. IMPLICATIONS: The ECLIPPx model offers a new approach for personal reflection and longitudinal learning, one that gives flexibility to the user whilst simultaneously encompassing the many relatively new areas of competence and expertise that are now required of a modern doctor.