AimsTo study the provision of paediatric liver services in a regional centre in the South of EnglandMethodsChildren with liver diseases seen in paediatric Hepatology clinics over the last 5 years were included in the study. Details of demographics, underlying diagnosis, investigations and treatments were extracted in a database.ResultsThere are two paediatric liver clinics in Southampton; one in conjunction with the supra-regional liver centre in London and the other a regional transitional clinic, with 3 consultants (supraregional, regional and transitional), dietetic, specialist nursing support and representation of the national charity Children Liver Disease Foundation in the clinics. Overall 223 children (Median Age: 12.2 years IQR: 6.8–17.1 years) were seen in the services (M:F 54.7:45.3) over the last 5 years (45 patients diagnosed/year). Children were referred from 11 hospitals across the network (Hampshire, Dorset, Wiltshire and Sussex). The most common 3 diagnoses seen in the clinics were Alpha-1-Antitrypsin deficiency (17%), Viral Hepatitides (11.7%) and Autoimmune liver disease (9.9%). With an increasing national incidence, 9.4% of the children presented with fatty liver and 15 patients with liver transplant are seen in the services. Nearly a third of patients graduated from the joint supra-regional clinic to the regional transitional clinic with provision of local radiology, bile duct stenting, bile duct botox and variceal banding services (endoscopic).ConclusionsThis study reflects the busy work load of a regional liver paediatric gastroenterology centre in the South of England. The paediatric liver services bridge an important gap between DGHs and supra-regional centres providing family centred specialist care for children with liver diseases, at convenience and closer to their homes. With an increasing new patient referral from DGHs and nearly third of patients transitioning to adult services, the need of a regional hepatology transitional clinic cannot be underestimated which can work in tandem with the joint supra-regional liver clinics providing uninterrupted smooth transition and continuity of care. With these increasing responsibilities, the role of a regional paediatric GI centre needs to be better recognised in managing paediatric liver patients, as currently highlighted in the NHS England specialist liver disease services contract.
Aims1) To determine whether infants presenting with a new diagnosis of regurgitation plus ‘red flag’ symptoms are appropriately investigated and managed in accordance with NICE NG1 guidelines and NICE quality standards. 2) To ascertain if the NICE audit tool is useful in clinical practice.MethodCohort consisted of a random sample of 30 paediatric inpatients aged <1 year with a new diagnosis of GORD (April 2015 to April 2016) presenting to a moderate sized DGH (6000 paediatric admissions per annum). Paper and computer notes reviewed.ResultsAbstract G188(P) Table 1Red FlagsResults1. Projectile vomiting.67% non-projectile. 27% projectile - none referred to surgeons. 6% not documented.2. Bile stained vomit.94% non-bilious. 6% colour not documented.3. Haematemesis3% - streaks of blood in vomit (Mallory Weiss) - local OPD follow-up arranged.4. Onset of regurgitation and/or vomiting>6 months old or persisting>1 year old.0%5. Blood in stool.88% no blood in stool. 6% colour not documented. 6% bowel habit not documented.6. Abdominal distension, tenderness or palpable mass.97% normal abdomen. 3% distended abdomen - admitted but not referred to surgeons.7. Chronic diarrhoea.94% normal stool. 6% bowel habit not documented.8. Appearing unwell/fever.0%9. Dysuria.10% no dysuria. 90% no documentation (50% urinalysis performed).10. Bulging fontanelle.94% normal fontanelle. 6% examination of fontanelle not documented.11. Rapidly increasing head circumference/ morning headache and vomiting worse in the morning.0% head circumference documented. 0% documentation of headache/morning vomiting.12. Altered responsiveness.88% normal responsiveness. 12% altered consciousness - 6% discharged after observation, 6% admitted overnight for further investigation/observation.13. Infants and children with/high risk of atopy.20% high risk of atopy - 10% outpatient clinic follow-up.ConclusionsThe NICE audit tool for GORD was easy to use and helpful in analysing results. Generally there was good documentation of red flags for GORD: recommendations for change included checking head circumference routinely. There were differing managements in the assessment of projectile vomiting and dysuria in infants which is further discussed. This is the first published audit using the NICE audit tool for GORD, and first assessment of how a moderate-sized DGH looks for red-flags in GORD.
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