G188(P) Gastro-oesophageal reflux disease in children: ‘Red flags’ clinical audit

Abstract

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.