Cost benefit analysis of amethocaine (Ametop) compared with EMLA for intravenous cannulation in a children's emergency department.

INTRODUCTION: Starship Hospital Children's Emergency Department (CED) uses EMLA for topical anaesthesia during insertion of intravenous cannula (IVC). Amethocaine has recently been shown to offer more effective pain relief and work faster than EMLA, but may be more expensive. AIM: To determine cost implications of introducing topical amethocaine into CED practice. METHODS: Data were obtained from a randomised controlled trial, quality assurance project and an audit of topical anaesthetic use, with economic evaluation performed from the District Health Board perspective in 2007 NZ dollars and Euros. Proportion of children receiving topical anaesthetic cream during insertion of IVC was the primary benefit measure, and cost per child presenting to the department was the primary cost measure. A decision tree model was developed as a baseline, and sensitivity analysis was conducted. Multiple clinical scenarios were modelled, and incremental cost effectiveness ratios calculated compared to the baseline model. RESULTS: Scenarios modelled include providing no topical anaesthesia, using amethocaine exclusively or using a mixture of amethocaine and EMLA. All models are sensitive to the amount of cream applied at triage. The most cost effective model provided EMLA at triage to those most likely to need IVC; then amethocaine to other children later thought to require IVC. This model would cost NZ$1.05 per child, down from NZ$1.47. Proportion of children receiving cream during insertion of IVC would increase from 51% to 64%. The recommended model dominated the current situation. CONCLUSION: Use of amethocaine in a mixed model in the CED could reduce cost and increase the proportion of children receiving topical anaesthetic during insertion of IVC. Trial registration number Australian New Zealand Clinical Trials Register ACTRN12606000409572.

Paediatric pedestrian trauma: the danger after school.

AIM: To examine the demographics of road pedestrian trauma in children in the Auckland region and to provide data that can help target prevention strategies. METHODS: A retrospective analysis was conducted of all children (0-14 years) in the Auckland region admitted to the hospital or killed following a pedestrian versus vehicle injury for the 6-year period 2000-2005. Excluded were pedestrians injured in a driveway. RESULTS: Over the 6-year period, 364 children were involved in pedestrian crashes resulting in 25 deaths. The median age was 7 years. Males comprised 63%. Pacific Islanders and Maori were over-represented. Three hundred seventeen patients had injury times recorded. Of these, 49% occurred between 3 and 7 pm. Injury peaks for school days showed a tri-modal pattern with injury peaks at 8-9 am, 3-4 pm and 5-6 pm with the 3-4 pm after-school peak predominating. CONCLUSION: Prevention strategies should concentrate on the hours after school finishes and should be tailored for Maori and Pacific Island communities.

Paediatric driveway run-over injuries: time to redesign?

AIMS: To investigate the demographic, accident, and environmental characteristics associated with driveway run-over injuries in order to identify potentially modifiable factors and prevention strategies METHODS: Retrospective review of all children less than 15 years old who were hospitalised or killed due to a driveway run-over injury in the Auckland region of New Zealand over the 50-month period, November 2001 to December 2005. Data was collected on the demographics, accident and environmental characteristics, and parental awareness. Data was obtained from clinical records and telephone interviews with parents. RESULTS: A total of 93 cases were identified, including 9 fatalities. The median age was 2 years with 73% under 5 years old. Children of Pacific Island and Maori ethnicity comprised 43% and 25% of cases respectively. Injuries occurred predominately on the child's home driveway (80% of cases). In 64% the driveway was the usual play area for the child. Only 13% of driveways were fenced. 51% were long driveways extending through the section, and 51% were shared with other properties. 51% of properties were rented and of these 57% were government houses. CONCLUSION: The absence of physical separation between driveways and children's play and living areas may predispose to driveway injuries. Further research is needed to investigate the ideal way to implement such separation in current properties and future property developments.