PUKINGLESSPERPOUNDFORACUTEWHEEZERSQUALITYIMPROVEMENTINAPAEDIATRICEMERGENCYDEPARTMENTBenKennedyRoisinMcDonaldGailDavisonJoshRuddellMichelleTroutonVikkiONeillJosephMcCannBrigitteBartholomeHeat ID: 937599
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ConsiderationshouldbegiventoregularNationalremoteteachingsthroughRoyalCollegeofPaediatricsandChildHealthsotraineesmentionedabovecanstayconnectedwitheachotherandbenefitfromremainingupdatedwithclinicalknowledgeuntiltheirreturntowork.AssociationofPaediatricEmergency PUKINGLESSPERPOUND,FORACUTEWHEEZERS:QUALITYIMPROVEMENTINAPAEDIATRICEMERGENCYDEPARTMENTBenKennedy,RoisinMcDonald,GailDavison,JoshRuddell,MichelleTrouton,VikkiONeill,JosephMcCann,BrigitteBartholome,HeatherSteen,MichaelShields,StephenMullen.RoyalBelfastHospitalforSickChildrenQueensUniversityBelfast10.1136/archdischild-2021-rcpch.83AcutewheezingattacksarealeadingcauseofPaediatricEmergencyDepartment(PED)attendancesandinpa-tientadmissionsandareaconsiderableburdenontheNHS.Almostone-thirdofchildrenvomitprednisoloneinthePED,requiringanti-emeticsandrepeatdosing.Single-dosedexame-thasone(600mcg/kgor300mcg/kg)isanon-inferioralterna-tivetoa3-daycourseofprednisolone(1mg/kg),withtheaddedadvantageofimprovedtolerabilityandpotentiallyreducedcost.UseofDexamethasonewithinastructuredpro-tocol(whichhaveshownsomereductioninmedicationdeliv-erytimesandlengthofstay(LOS))wouldlikelyfacilitatetolerabilityandPEDpatientflow.ThisQIinterventionaimedtoimproveOralCor-tico-Steroid(OCS)tolerability,reduceLOSintheemergencydepartment,andreduceOCSdrugcostsforacutewheezeattendancesinaUKPED,whilenotadverselyaffectingadmis-sions,re-attendance,ormortalityrates.Thestudyteamreviewedtheevidenceandimple-mentedadepartmentalwheezeprotocol.OCStypeanddosewasmodifiedinsubsequentyears.Standarddosingin2016wasa3daycourseofprednisolone12mg/kg.Thiswaschangedtoasingledoseofdexamethasone600mcg/kgin2017,thenrevisedagaintoasingledoseDexame-thasone300mcg/kgin2018.Toassessthescaleofimprovement,weretrospectivelycollecteddataonattend-ancerecordsforpatients214yearswithacutewheezerequiringOCS.Wecollecteddataon100childrenwhoattendedPEDbetweenOctoberandDecemberforeachyear(2016,2017and2018).WethenassessedOCStoler-ability,LOS,OCSdrug-cost,andadmission,re-attendance,andmortalityrates.Overa48-monthperiod,weincreasedOCStolerabil-ityby67.2%.Therewasan85.8%reductioninOCSdrugcosts,saving£41,553.14.TherewasnochangeintheLOS,admission,re-attendance,andmortalityrates.ImprovedtolerabilityandsubstantialcostsavingscanbeachievedbyimplementingastructuredacutepaediatricwheezeprotocolandmodifyingtheOCStosingle-dosedexa-methasone(300mcg/kg).BritishSocietyofPaediatricGastroenterology,HepatologyandNutrition INFANTILEBERIBERIASACAUSEOFACUTEINFANTILEENCEPHALOPATHYINAREFERRALHOSPITALINSOUTHERNBHUTANDineshPradhan,PurushottamBhandari,DorjiGyeltshen.CentralRegionalReferralHospital,Gelephu,Bhutan10.1136/archdischild-2021-rcpch.84Thiaminedeficiencymayleadtoacuteencephal-opathy(infantileberiberi/infantileWernickesencephalopathy)andresemblesinfectionslikemeningitisandacuteencephalitissyndrome(AES)/meningoencephalitis.Infantswithacuteence-phalopathyadmittedtothePediatricDepartmentofCentralRegionalReferralHospital(CRRH)inGelephu,Bhutan,his-toricallyhadhighmortality�(70%).InAugust2018,suspect-ingthiaminedeficiencyasapossiblecause,aprotocolwasdeployedtoadministerthiaminetoallchildrenwithacuteencephalopathy.ObjectivesWeaimedtodescribetheclinicalpresentationofchildrenadmittedwithacuteencephalopathyfromJanuary2015-December2020,comparingmorbidityandmortalityout-comebeforeandafteradministrationofthiamine.Weretrospectivelycollectedrecord-baseddatafromchildren159months,admittedwithacuteencephalopathybetweenJanuary2015-December2020,includingclinicalpre-sentation,laboratoryresultsandinvestigationssuchascere-brospinalfluidanalysisandneuroimaging.Weexcludedchildrenwithinfectiousmeningitis,chronicneurodegenerativedisordersandtraumaticbraininjury.Datawasanalyzedtoassesschangesinmorbidityandmortalityoutcomebefore(GroupA:January12015-July312018)andafter(GroupB:August12018-December312020)thethiamineadmin-istrationprotocol.Inthe6yearperiod,153children(40.5%female)presentedwithacuteencephalopathywithamedianageof3months(IQR1.5to4),and88.2%below6months.Almostall(99.3%)werebornatterm,andmajority(88.9%)wereexclusivelybreastfed.Therewerenosignificantdifferencesbetweenchildrenwhodidnotreceivethiamine(65;42.5%)andthosewhoreceivedthiamine(88;57.5%)withrespecttoage,gender,gestationalageatbirth.Themostcommonpre-sentationwasirritabilityfollowedbyseizuresandreducedsensorium.Overall,59childrendied(38.6%),mostofwhomhadnotreceivedthiamine(GroupAmortalityrate81.5%,GroupBmortalityrate6.8%,p0.001).Adisproportionatenumberofdeathswerenotedininfantsbelow6monthsofage(81.4%).Respiratoryfailurewasthemostcommonmorbidityfollowedbyshock,andacutekidneyinjury.Therewasasignificantlylowerincidenceofrespiratoryfailure0.001)andshock(p=0.003)inchildrenwhoreceivedInchildrenadmittedwithacuteencephalopathy,administrationofthiamineappearedtosignificantlyreducemortalityandmorbidity.Prospectivestudiesofchildrenpre-sentingwithacuteencephalopathy,includingmeasurementofthiaminelevels,mayvalidateourpreliminaryfindingssugges-tiveofacuteinfantileberiberi. ArchDisChild(Suppl1):A1