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1138 Time for a change? A pragmatic approach to investigating non-accidental injuries could potentially save significant amounts of money in a cash-strapped NHS

Archives of disease in childhood, 2022-08, Vol.107 (Suppl 2), p.A294-A295 [Peer Reviewed Journal]

Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ. ;2022 Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ. ;ISSN: 0003-9888 ;EISSN: 1468-2044 ;DOI: 10.1136/archdischild-2022-rcpch.477

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  • Title:
    1138 Time for a change? A pragmatic approach to investigating non-accidental injuries could potentially save significant amounts of money in a cash-strapped NHS
  • Author: Yeoh, Irvin ; Saran, Shashwat ; Aung, Nini
  • Subjects: Abstracts ; Child abuse ; Children ; Children & youth ; Costs ; Hematological diseases ; Hematology ; Laboratories ; Pediatrics ; Von Willebrand factor
  • Is Part Of: Archives of disease in childhood, 2022-08, Vol.107 (Suppl 2), p.A294-A295
  • Description: AimsDistinguishing unintentional from non-accidental injuries (NAI) can be challenging, necessitating the clinical acumen of experienced clinicians to offer opinions to the probabilities of abuse. National guidelines on haematological investigations exist to aid the interrogation of these cases.1 However, little is said about the costs associated with extensive workups which could be financially detrimental to an already struggling healthcare system. In addition to evaluating quality adherence to existing guidelines, we aim to assess if current recommendations are valuable in reaching meaningful conclusions in the context of NAI and identifying haematological disorders at first presentation.MethodsThis re-audit studied all children under the age of 16 who required haematological investigations as part of the Child Protection workup from October 2020 till November 2021. Children who were not suspected for NAI or haematological disorders were excluded.ResultsAll 35 boys and 21 girls were referred for suspected NAI (n=56). The distributions by age were <1 month (0), 1-6 months (8), 6-24 months (23), and ≥24 months (25). 100% of patients adhered fully to the recommended first-line investigations. Extended coagulation profiles (Factors VIIIc, XIII and Von Willebrand factor) were performed at a neighbouring Trust, taking a mean of 13 days to obtain the results. The commonest abnormal result was Von Willebrand factor (23.2%), which also makes the commonest indication for haematology referrals. Out of 12 total cases, 2 were discussed locally and 10 were referred to the tertiary paediatric haematologist, whereby the latter required an average of 36 days till an outcome. None were eventually deemed to be Von Willebrand Disease and only one case was concluded to be NAI. Table 1 highlights the frequencies of false abnormal results from repeat testing. Sourcing previous years’ national reference costs,2 the estimated expenses for all first-line investigations excluding repeat tests were >£50.Abstract 1138 Table 1Adherence to first-line investigations and the frequencies of false abnormal resultsConclusionThis reaudit has demonstrated substantial local improvement in adherence to the national guidelines, following the implementation of a WebICE NAI Panel of Investigations as recommended during the first cycle. There were tendencies to depend on tertiary services for processing laboratory results and obtaining paediatric haematology input, inevitably prolonging wait times. Local services, particularly haematology should be the initial point of contact for discussing cases. None of the children were eventually found to have bleeding disorders. Coupled with the substantial degree of false abnormal rates in repeat testing, this raises two serious questions – are these reliable screening tests, and has practice moved into heavy reliance on laboratory investigations as compared to clinical acumen? We infer that most abnormal results were attributed to the ‘acute phase’ during initial presentation, hence it is vital to repeat any abnormal result prior to commencing treatments. In a movement to maximize cost-efficiencies within the NHS, our recommendations remain two-fold; we urge the College to revisit its current guidance specifically on revising first-line haematological investigations, and district general hospitals to optimize the use of local resources.ReferencesRCPCH, 2022. Chapter 9: Recognition of Physical Abuse – RCPCH Child Protection Portal. URL: https://childprotection.rcpch.ac.uk/child-protection-companion-content/chapter-9-recognition-of-physical-abuse/ Improvement, N.H.S., 2020. Archived reference costs. URL: https://improvement.nhs.uk/resources/reference-costs/
  • Publisher: London: BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health
  • Language: English
  • Identifier: ISSN: 0003-9888
    EISSN: 1468-2044
    DOI: 10.1136/archdischild-2022-rcpch.477
  • Source: Alma/SFX Local Collection
    ProQuest Central
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