This study provides an updated risk estimate for bloodstream infections in children with cancer and adds to the framework for developing evidence-based guidance for management of suspected infections in this highly vulnerable group.

Although infection was suspected in almost half the children admitted to hospital, a significant pathogen was cultured from blood or CSF in only 2.4%, mainly among children with pre-existing co-morbidities, who may require a more broad-spectrum empiric antibiotic regime compared to previously healthy children. Invasive bacterial infection in previously healthy children is now very rare. Improved strategies to manage low-risk febrile children are required.

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AimsTo review health seeking behaviour patterns of looked after children and young people (LACYP) who present to a local Accident and Emergency (A&E).MethodData was retrospectively reviewed from 1st September 2014–31st March 2015. This included: age, LACYP type and reason, frequency and outcome of attendance. Non local LACYP and, or non-local A&E attendance were excluded. Data was anonymised and analysed.Results Figure 1 – Initially 88 attendances were generated by 49 LACYP (chart 1). Our population of interest, Local LACYP and Unaccompanied Asylum Seeking Children (UASC), totalled 31 and had 47 presentations. The distribution shows 90% (28 of 31) are aged 12 to 18 years (graph 1). Figure 2 – Of the 47 presentations 36 are for reasons shared between the local LACYP and UASC (graph 2). Musculoskeletal attendances (including soft tissue injury, limb pain and sprains) are commonest totalling 33% (12 of 36) of presentations. Assault and mental health issues (including self-harm, substance abuse and suicidal intent) each account for 16% (6 of 36) of presentations. The 11 remaining reasons for local LACYP vary; although 5 are for upper respiratory tract infections (URTI). Figure 3 – Outcomes of the 47 presentations are: 81% (38) discharged, 13% (6) admitted, 4% (2) referred and 2% (1) did not wait.Abstract G601(P) Figure 1Abstract G601(P) Figure 2Abstract G601(P) Figure 3ConclusionsCommon shared presentations between local LACYP and UASC are for mental health issues and assault, which re-iterates that LACYP are a vulnerable population.1 Interestingly musculoskeletal complaints are the commonest presentation and the majority of our local LACYP and UASC are over 12 years old; significance of these observations should be explored further. Reasons for attendance to the local A&E are considered appropriate; although some presentations like URTI could equally be reviewed in a General Practice (GP) setting. There is no evidence that UASC are using A&E instead of their GP. Limitations of the data include: small sample size, potential non-reported LACYP attendances to local A&E and lack of comparative data of general population attendance patterns. This data has implications for future planning, including closer integration of mental health within LACYP services. Future research could compare LACYP attendances to the non LACYP population.ReferenceNICE (2010) PH28 Looked-after children and young people guideline