What do we really know about infants who attend Accident and Emergency departments?

Abstract

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 1st April 2009 to 30th 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.