RCEM Recommends Better Recording of Vital Signs in Children Following Clinical Audit

The Royal College of Emergency Medicine is calling for better of vital signs in children who attend Emergency Departments (EDs) after a clinical audit found that nearly a third are not using a formalised scoring system.


Royal College of Emergency Medicine

A report published today by the RCEM into the recording of vital signs in children under the age of 16 years with a medical illness (as opposed to an injury), found that just over 30% of the 191 EDs audited were not using a formal system.

Paediatric attendances account for 25% of ED attendances and the timely and accurate recording of vital signs are important because, if abnormal, it can indicate a disease or underlying health problem.

Early detection of abnormal vital signs is important to allow the appropriate assessment and treatment to take place and prevent the patient from deteriorating.

However, the report found that documentation is generally good,with the majority of EDs using the Paediatric Early Warning Scores (PEWS) system to record results.

Dr Cliff Mann, President of the Royal College of Emergency Medicine said: "This audit confirms that there is much good practice in Emergency Departments but highlights disparate assessment methods for these patients.

"The audit shows that one third of children presenting to emergency departments are infants - those below 2 years old who have limited ability to communicate symptoms and are therefore the most challenging.

"Paediatric Emergency Medicine is particularly challenging because we know there will be a few very sick children amongst the many children with similar symptoms who have a self-limiting illness – the needles in the haystack.

"In the paediatric population we know that standardised assessment and scoring methods can help clinicians spot the sick children but no tool is currently sufficiently sensitive or specific.

"To enable sick children to be identified, there is a clear need to agree a standardised scoring method that all clinicians can use."

The report recommends the use of PEWS or an equivalent early warning score and Dr Mann called for other Colleges to encourage the use of a formalised system: "The RCEM Audit committee and Quality in Emergency Care committee will liaise with other expert bodies such as the Royal College of Paediatrics and Child Health to promote greater standardisation."

Dr John Criddle, Chair of the Royal College of Paediatrics and Child Health's emergency care committee, said: "Children make up nearly a quarter of total attendances at A&E and a significant proportion present with conditions such as fever, wheeze and breathing difficulties. Often these conditions are dealt with quickly and easily but sometimes there can be underlying issues which can go unrecognised if vital signs are not recorded – sometimes with grave consequences.

"We therefore welcome the recommendations made by the RCEM in today's report which reiterate the Intercollegiate Standards for Children and Young People in Emergency Care Settings. All children and young people should receive an initial assessment within 15 minutes of arrival to ensure that we minimise the likelihood of missing serious illness in this challenging group of patients."

This was the first time this audit has been conducted on a paediatric population, having previously been run on an adult population in 2010. In total 16,231 children presenting to 191 EDswere included in the audit.


Source: RCEM



Better recording of vital signs in children is needed following clinical audit

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