Children who harm themselves: development of a paediatric emergency department triage tool.

INTRODUCTION: Children who harm, hurt or kill themselves are a significant issue for health professionals in emergency departments (ED), with over 60 000 young people presenting to ED in the UK each year following self-harm. METHODS: In response to the development of a regional integrated pathway for the management of self-harm encompassing acute care, primary care and child and adolescent mental health services, it was felt that a triage tool developed specifically for children and young people presenting with self-harm was required. A multidisciplinary group encompassing nursing, managerial and medical staff from both paediatric emergency and child and adolescent mental health services was convened to determine the priorities for this tool. In this paper the development of this paediatric-specific triage tool is discussed focusing on suicide risk, substance misuse and physical issues associated with the common presentations of self-harm in young people. The available literature is also reviewed and the multidisciplinary approach to developing a user-friendly tool is discussed. RESULTS: A modified risk of suicide questionnaire, the CRAFFT questionnaire, and three questions about physical manifestations of self-harm were used to form a 14-point triage/screening tool, requiring only yes/no answers. CONCLUSION: A paediatric triage tool was developed that allows the more appropriate triage of young people who harm themselves and is acceptable to all stakeholders involved in their care.

Not a NICE CT protocol for the acutely head injured child.

AIM: To assess the impact of the introduction of the Birmingham Children's Hospital (BCH) head injury computed tomography (CT) guidelines, when compared with the National Institute of Health and Clinical Excellence (NICE) guidelines, on the number of children with head injuries referred from the Emergency Department (ED) undergoing a CT examination of the head. MATERIAL AND METHODS: All children attending BCH ED over a 6-month period with any severity of head injury were included in the study. ED case notes were reviewed and data were collected on a specifically designed proforma. Indications for a CT examination according to both NICE and BCH head injury guidelines and whether or not CT examinations were performed were recorded. RESULTS: A total of 1428 children attended the BCH ED following a head injury in the 6-month period. The median age was 4 years (range 6 days to 15 years) and 65% were boys. Four percent of children were referred for a CT using BCH guidelines and were appropriately examined. If the NICE guidelines had been strictly adhered to a further 8% of children would have undergone a CT examination of the head. All of these children were discharged without complication. The remaining 88% had no indication for CT examination by either BCH or NICE and appropriately did not undergo CT. CONCLUSIONS: Adherence to the NICE head injury guidelines would have resulted in a three-fold increase in the total number of CT examinations of the head. The BCH head injury guidelines are both safe and appropriate in the setting of a large children's hospital experienced in the management of children with head injuries.