If you were a doctor in an ED department 15 years ago it looks like you were having a pretty easy time of it.
Research by @PeterJGill, others and myself, has shown that there has been a big year on year rise in admissions for children.
From 1999 to 2010 emergency rose by from 63 per 1000 children to 81 per 1000, with the greatest rise in those under five. Published in Archives of Disease in Childhood and highlighted on the BBC news the study showed 739,000 children under 15 were admitted in 2010, up from 594,000 in 1999. In 2010, just over 2/3rds of admissions were among the under 5s.
Most of this rise is due to common infections. Whilst admission rates for long term conditions fell over time, acute infections of the upper respiratory tract rose by 22%, lower respiratory tract by 40%, and UTIs by 43%.
The problem is also set to get worse. By 2020 we can expect to see 230,000 more admissions in under 5s than the current figures.
Indeed it could get much worse. Anyone who understands pre-test probability will realize that the pre-test of serious infection gets much lower if more people just simply turn up. Making it much harder to rule in disease. Leading to more children admitted, and in turn reinforcing admission seeking behavior of both the parents and doctors.
There are many reasons that this rise has occurred, changes in practice, poorly trained doctors, risk aversion; but not many will realize how poorly we have educated, in terms of health seeking behavior, the population at large. Diseases like influenza are now ‘must see a doctor diseases,’ despite the fact they are largely self-limiting in nature.
Andy Lee
February 12, 2013 at 10:25 pmSome of the increase in diagnoses of acute infections is down to changing patterns of investigation and interpretation. LRTIs are diagnosed on minor radiological change and UTIs are tested for more often. These children did not in the main have worse outcomes previously when not admitted with the same episodes of illness that were simply managed as unspecified febrile episodes or URTIs. The main factors to the overall increase are parental behaviour and the incentive under PBR for hospitals to admit. Hopefully CCGs now have an incentive to change that trend and the clinical leadership to make it happen. Unplanned care services need to be commissioned with the incentive to reverse this trend, since it is not clinically beneficial.