RESUMO
OBJECTIVE: To systematically review the literature describing children and young people (CYP) admissions to paediatric general wards because of primary mental health (MH) reasons, particularly in MH crisis. DESIGN: PubMed, Embase, PsycINFO, Web of Science and Google Scholar were searched, with no restriction on country or language. We addressed five search questions to inform: trends and/or the number of admissions, the risk factors for adverse care, the experiences of CYP, families/carers and healthcare professionals (HCPs) and the evidence of interventions aimed at improving the care during admissions.Two reviewers independently assessed the relevance of abstracts identified, extracted data and undertook quality assessment. This review was registered with PROSPERO (CRD42022350655). RESULTS: Thirty-two studies met the inclusion criteria. Eighteen addressed trends and/or numbers/proportions of admissions, 12 provided data about the views/experiences of HCPs, two provided data about CYP's experiences and four explored improving care. We were unable to identify studies examining risk factors for harm during admissions, but studies did report the length of stay in general paediatric/adult settings while waiting for specialised care, which could be considered a risk factor while caring for this group. CONCLUSIONS: MH admissions to children's wards are a long-standing issue and are increasing. CYP will continue to need to be admitted in crisis, with paediatric wards a common location while waiting for assessment. For services to be delivered effectively and for CYP and their families/carers to feel supported and HCPs to feel confident, we need to facilitate more integrated physical and MH pathways of care. PROSPERO REGISTRATION NUMBER: CRD42022350655.
RESUMO
OBJECTIVE: To undertake a systematic review of reviews of the prevalence of symptoms and signs of COVID-19 in those aged under 20 years. DESIGN: Narrative systematic review of reviews. PubMed, medRxiv, Europe PMC and COVID-19 Living Evidence Database were searched on 9 October 2020. SETTING: All settings, including hospitalised and community settings. PATIENTS: Children and young people (CYP) under age 20 years with laboratory-proven COVID-19. STUDY REVIEW, DATA EXTRACTION AND QUALITY: Potentially eligible articles were reviewed on title and abstract by one reviewer. Quality was assessed using the modified AMSTARS criteria and data were extracted from included studies by two reviewers. MAIN OUTCOME MEASURES: Prevalence of symptoms and signs of COVID-19. RESULTS: 1325 studies were identified and 18 reviews were included. Eight were high quality, 7 medium and 3 low quality. All reviews were dominated by studies of hospitalised children. The proportion of asymptomatic CYP ranged from 14.6% to 42%. Fever and cough were the the most common symptoms; proportions with fever ranged from 46% to 64.2% and with cough from 32% to 55.9%. All other symptoms or signs including rhinorrhoea, sore throat, headache, fatigue/myalgia and gastrointestinal symptoms including diarrhoea and vomiting were infrequent, occurring in less than 10%-20%. CONCLUSIONS: Fever and cough are the most common symptoms in CYP with COVID-19, with other symptoms infrequent. Further research on symptoms in community samples are needed to inform pragmatic identification and testing programmes for CYP.
RESUMO
OBJECTIVE: To compare cause-specific UK mortality in children and young people (CYP) with EU15+ countries (European Union countries pre-2004, Australia, Canada and Norway). DESIGN: Mortality estimates were coded from the WHO World Mortality Database. Causes of death were mapped using the Global Burden of Disease mortality hierarchy to 22 cause groups. We compared UK mortality by cause, age group and sex with EU15+ countries in 2015 (or latest available) using Poisson regression models. We then ranked the UK compared with the EU15+ for each cause. SETTING: The UK and EU15+ countries. PARTICIPANTS: CYP aged 1-19. MAIN OUTCOME MEASURE: Mortality rate per 100 000 and number of deaths. RESULTS: UK mortality in 2015 was significantly higher than the EU15+ for common infections (both sexes aged 1-9, boys aged 10-14 and girls aged 15-19); chronic respiratory conditions (both sexes aged 5-14); and digestive, neurological and diabetes/urological/blood/endocrine conditions (girls aged 15-19). UK mortality was significantly lower for transport injuries (boys aged 15-19). The UK had the worst to third worst mortality rank for common infections in both sexes and all age groups, and in five out of eight non-communicable disease (NCD) causes in both sexes in at least one age group. UK mortality rank for injuries in 2015 was in the top half of countries for most causes. CONCLUSIONS: UK CYP mortality is higher than a group of comparable countries for common infections and multiple NCD causes. Excess UK CYP mortality may be amenable to health system strengthening.
