Aims: To describe the validation and reliability of a new pain tool (the Alder Hey Triage Pain Score, AHTPS) for children at triage in the accident and emergency (A&E) setting. Methods: A new behavioural observational pain tool was developed because of dissatisfaction with available tools and a lack of confidence in self-assessment scores at triage. The study was conducted in a large paediatric A&E department; 575 children (aged 0-16 years) were included. Inter-rater reliability and various aspects of validity were assessed. In addition this tool was compared to the Wong-Baker selfassessment tool.1 The children were concurrently scored by a research nurse and triage nurses to assess inter-rater reliability. Construct validity was assessed by comparing the research nurse's triage score with the research nurse reassessment score after intervention and/or analgesia. Known group construct validity was assessed by comparing the research nurse's score at triage with the level of pain of the condition as judged by the discharge diagnosis. Predictive validity was assessed by comparing the research nurse's AHTPS with the level of analgesia needed by each patient. The AHTPS was also compared to a selfassessment score. Results: A high level of inter-rater reliability, kappa statistic 0.84 (95% CI 0.80 to 0.88), was shown. Construct validity was well demonstrated; known group construct validity and predictive validity were also demonstrated to a varying degree.
Conclusions:Results support the use of this observational pain scoring tool in the triage of children in A&E.
Objective: To examine the outcomes of calls to NHS Direct (NHS-D) in relation to attendance at the accident and emergency (A&E) department. Design: A prospective collection of data about consecutive calls to NHS-D North West Coast was matched with attendances at the A&E department over a period of 3 months. Setting: NHS-D Regional Trust and a large urban paediatric A&E department. Patients: Children and young adults aged ,16 years living in local postal code areas. Main outcome measures: To examine (1) whether advice given by NHS-D was followed and (2) the differences in disease severity and necessity of attendance of patients referred by NHS-D and those referred by general practitioners and self-presenters. Results: The relationship between the advice given and subsequent action is complex. Only 70% of calls advised to attend the A&E department did so. A further 1% (176) were advised not to attend the A&E department did in fact attend the department. Patients referred by NHS-D represented only 3.2% of department attendances. There was little difference in the triage categories of the presenting groups, but there were significantly less admissions (p,0.01) in the NHS-D group. Conclusions: Delivering telephone advice about illness severity in children is difficult as visual clues are so important. More collaborative prospective studies are needed, including with primary care, to understand families' choices, and to refine and assess NHS-D's ability to discriminate those requiring further clinical assessment.
This study measured changes in body mass index (BMI) of male youths upon admission and 3 months after admission to a long-term juvenile correctional facility and identified potential causes of obesity in this population. Health records for 159 youths admitted during an 18-month period were used to calculate the BMI for each. The annual dietary assessment, standard meal plans, and physical activity requirements also were reviewed. Upon admission, 12% of the youths were obese (BMI greater than 95th percentile for age and sex) and 26% were overweight (BMI between 85th and 95th percentiles). After 3 months, 66% were obese or overweight. Among the 23% of youths taking psychotropic medications, the percentage classified as obese or overweight rose from 59% to 78%. Factors contributing to overweight and obesity during incarceration include insufficient physical activity for the probable increased food intake and use of psychotropics. Another factor may be the Food and Drug Administration-approved school lunch program diet. More research is needed to learn whether these problems exist in other juvenile facilities.
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