Paediatric short stay unit in a community hospital: effective, efficient and popular.

OBJECTIVES: Short stay medicine is a cost-effective and efficient way to manage patients with suitable conditions. Paediatric acute illness and injury are amenable to short stay medicine. Before January 2004, when Maroondah Hospital recommenced inpatient care for children, 700 children were transferred annually to other hospitals. We describe the implementation and performance of the first paediatric short stay unit (SSU) in Victoria, which was designed to remedy this situation. METHODS: Set in a 291-bed metropolitan hospital, we audited paediatric emergency attendances, admissions, transfers and discharges. We present quality and consumer satisfaction data. RESULTS: The environment was designed for the physical, developmental and social needs of children. We implemented education, a system of exclusion criteria and pathways to enhance safety. Over 12 months, of 9097 paediatric attendances, 1101 required inpatient care. Among them, 862 patients were admitted to the SSU and 239 were transferred. Accordingly, 78% of admitted patients were cared for in-house. Median length of stay was 20 h. Of the 708 reviewed cases, there were 19 (3%) unexpected transfers from the SSU, 59 (8%) long stays (>48 h) and no deaths. Via a telephone survey, there were 30/355 (8%) unplanned representations and satisfaction data were overwhelmingly positive. We suggest that this model is suitable for centres with limited paediatric cover. In-house senior emergency physician cover might be preferable to an after-hours junior staff-only model. CONCLUSION: A co-located paediatric SSU within an ED is an efficient, popular and viable alternative for paediatric services to be delivered in a suburban setting.

The increasing problem of motorcycle injuries in children and adolescents.

OBJECTIVE: To quantify an anecdotally apparent increase in motorcycle-related injuries in children and adolescents across Victoria. DESIGN, SETTING AND PARTICIPANTS: Retrospective analysis of paediatric motorcycle injuries (1 July 2000 - 30 June 2004) from a statewide emergency department (ED) database (Victorian Emergency Minimum Dataset [VEMD]) and the Trauma Registry database at the Royal Children's Hospital (RCH), Melbourne. MAIN OUTCOME MEASURES: Trends in paediatric motorcycle-related injuries over time; patient demographics, circumstances of accidents (on or off road), and injury characteristics, including severity markers. RESULTS: The VEMD recorded 3163 patients aged < or = 16 years presenting to EDs with motorcycle injuries during the study period; population-based rates of these injuries increased by an average of 9.6% per year (95% CI, 6.2%-13.1%; P < 0.005). In the same period, there was a total of 167 motorcycle-related admissions to the RCH, increasing annually in line with statewide ED presentations. About a quarter of paediatric motorcycle accidents occurred in children aged under 10 years (VEMD, 22%; RCH, 27%) and most occurred off road (VEMD,89%; RCH, 71%). At the RCH, median length of stay was 3 days (interquartile range [IQR], 1-7 days) and the median Injury Severity Score was 9 (IQR, 4-10); 41% of patients required an operation, 13% were admitted to an intensive care unit, and two died. CONCLUSION: In Victoria, the incidence of motorcycle-related injuries is increasing in children and adolescents. Most of these injuries occur off road, outside of any legislative framework. There is an urgent need for coordinated legislative changes and educational efforts to decrease motorcycle injuries in children.

Health information seeking by parents in the Internet age.

AIM: Studies have shown increasing Internet use for health information. We aimed to broadly examine parents' utilisation of information sources for their children's health, their trust in them and to define the role of the Internet for children's health information METHODS: Interview of a convenience sample of parents of patients presenting to a tertiary paediatric emergency department (ED) (Royal Children's Hospital, Melbourne, Australia) in 2006/2007. RESULTS: A total of 360 parents completed the interview. Parents had used on average five sources of health information for their children in the previous 6 months. In the previous 6 months and immediately prior to the ED visit, general practitioners were consulted for health information by 87% and 39%, chemists by 44% and 2%, the Internet by 43% and 6% and telephone advice health lines by 30% and 10%, respectively. Of these sources, parents 'greatly trusted' Royal Children's Hospital ED doctors and nurses 82% (n = 112) their regular general practitioners in 73% (n = 303), chemists in 45% (n = 160), telephone advice health lines (Nurse-On-Call) in 42% (n = 90) and the Internet in general in 10% (n = 112). Overall, 52% had sought health information for their children on the Internet. Only 20% knew and 11% had ever used the regional children's hospital web site (http://www.rch.org.au/kidsinfo), but 97% of the Internet users reported they would trust this information. CONCLUSION: While using numerous different sources, parents in this study mostly use and trust traditional sources of health information. Scores of respondents use the Internet to seek health information for their children and would value easier access to Internet sources that they trust.

Topical lignocaine for pain relief in acute otitis media: results of a double-blind placebo-controlled randomised trial.

OBJECTIVE: Acute otitis media (AOM) is common in children, yet the optimal management of ear pain associated with AOM has not been well studied. We set out to determine the efficacy of topical aqueous 2% lignocaine eardrops compared with a placebo (saline) for pain relief of AOM in children. DESIGN: Double-blind, randomised, placebo-controlled trial. SETTING: Tertiary children's hospital emergency department. PATIENTS AND INTERVENTIONS: Children aged between 3 and 17 years with earache and AOM without evidence of perforation were eligible. Patients were randomised to receive either 2% lignocaine or saline eardrops (placebo). MAIN OUTCOME MEASURES: Pain scores were measured before and after ear-drop administration. Patient and physician-interpreted pain scores were measured by using the Bieri faces pain scale and visual analogue scale at 10, 20 and 30 minutes. The primary outcome measure was reduction in patient-measured pain scores by 50% from the baseline. Secondary outcome measures were reduction in patient-measured pain scores by 25% or by at least two points. Telephone follow-up occurred after 1 day and 1 week. Analysis was by intention to treat. RESULTS: 63 children (31 were treated with lignocaine, 32 with placebo) aged 3 to 12 years were enrolled. The groups were demographically and clinically similar, with similar proportions having received analgesia in the preceding 4 hours. Children receiving lignocaine showed significantly lower patient-measured pain scores with a reduction by 50% from baseline at 10 minutes (RR 2.06, 95% CI 1.03-4.11, p = 0.03) and 30 minutes (RR 1.44, 95% CI 1.07-1.93, p = 0.009) but not at 20 minutes (RR 1.35 95% CI 0.88-2.06). The response to lignocaine treatment showed significantly lower patient-measured pain scores for 25% reduction at all time points and for two-point reduction at 10 minutes and favoured lignocaine at 20 minutes and 30 minutes without reaching statistical significance. There were no serious adverse events during the 30 minute follow-up period. CONCLUSION: This study suggests that topical aqueous 2% lignocaine eardrops provide rapid relief for many young children presenting with ear pain attributed to AOM. The concurrent use of simple oral analgesia is a likely contributor to effective management of this painful childhood condition.