Infants with head injuries-do all need hospital admission?

BACKGROUND: Head injury in a young infant is a common presentation in paediatric emergency departments and clinicians often admit these young infants (less than 12 months of age) for further neuro-observation due to lack of strong evidence base and standard recommendations about the management of such a young patient with head injury. AIMS: We performed this retrospective observational study to find out whether inpatient admission is really necessary in those infants who present with minor head injury to the paediatric emergency departments. METHODS: Electronic patient record system and handwritten patient records were retrospectively accessed of the infants admitted with minor head injury to the paediatric ward of the Midland Regional Hospital, Mullingar over a period of the previous 5 years. RESULTS: A total of 256 infants less than 12 months of age met the criteria of minor head injury at admission and none of them showed any clinical indicators indicating serious intracranial injury whilst under observation in the paediatric ward. They all remained well and were discharged later after a period of observation. CONCLUSIONS: Barring few clinical circumstances which put these young infants at increased risk of clinically important traumatic brain injury, a vast majority of minor head injury in infants can be safely observed at home with reliable caretakers and proper discharge instructions.

Emergency review clinic: impact on paediatric admissions.

BACKGROUND: Inappropriate or unnecessary paediatric inpatient admissions are sometimes unavoidable but are costly and increase pressure on services. Various measures, including paediatric observation units, have been undertaken in an attempt to reduce these admissions. AIMS: We established an emergency review clinic to assess whether we could reduce admission rates by giving carefully selected children follow-up ED review appointments. METHODS: An emergency review clinic was run in the paediatric room of the Emergency Department by a senior paediatric registrar during the hours 10 a.m. to 12 midday, Monday to Friday inclusive. Patients were booked into this review clinic from ED. Data relating to paediatric admissions in the years prior to and after the institution of the review clinic were analysed. RESULTS: A significant reduction (p < 0.0001) was noted in the paediatric inpatient admission rates following establishment of the review clinic. CONCLUSIONS: A paediatric emergency review clinic can significantly reduce unnecessary or inappropriate admissions but more research is needed to quantitatively characterise parent/patient satisfaction in this regard.