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Guidelines based on presenting problems cut invasive procedures in children with diarrhoea or seizures

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Unnecessary invasive tests and treatment could be avoided for many children presenting as emergencies with diarrhoea or seizures if evidence based care guidelines were widely adopted, according to a UK hospital study.

Better management and significantly fuller clinical records resulted after guidelines for diarrhoea (with or without vomiting) and seizures (with or without fever) in children aged 0–15 years were implemented in the accident and emergency department. More children with diarrhoea had optimum rehydration according to their needs. Unnecessary intravenous infusions fell from 11 to one, as did the proportion of children undergoing invasive tests—for full blood count (4% v 11%) and urea and electrolytes (5% v 12%). Similarly, in children with seizures tests were significantly lower for urea and electrolytes (17% v 29%) and calcium concentration (10% v 23%).

The guidelines significantly speeded up assessments, though they raised the relative risk of admission—an outcome measure—for children with diarrhoea. These admissions were for observation and shorter stays than previously. Relative risk of admission for seizures was unchanged.

The prospective study was performed in 502 children with diarrhoea and 398 with seizure attending directly or referred by their general practitioner. Process and outcome measures were assessed for four months in early 1997 and a further four months two years later, after guidelines had been introduced.

Care pathways providing a clinical management “map” for doctors should improve management but have always been based before on diagnosis, not presenting problems.

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