We performed an activity analysis of the resuscitation room in our inner city paediatric emergency department. Data were entered prospectively onto a computer in the room by the nurse or doctor caring for each patient. Patient capture was checked against a separate audit in progress, and data retrospectively entered for missed patients (n = 7). The database was similar to that used in our adult resuscitation room,1 but modified for paediatric use.
Between November 2003 and October 2004, 21 207 new patients attended the paediatric emergency department and 139 (0.7%) of these passed through resuscitation. This has implications when planning new facilities, and suggests that flexible or shared resuscitation facilities may be appropriate in units seeing similar numbers of children but where adults also attend.
The diagnosis of the resuscitation room patients is shown in table 1. The breadth of conditions is striking, but the data also tell us where education should be focused.
Table 1 Diagnosis of children managed in the resuscitation room.
| Diagnosis | Number (%) |
|---|---|
| Seizures | 31 (22%) |
| Trauma | 22 (16%) |
| Apnoea/floppy spell | 9 (6%) |
| Bronchiolitis | 9 (6%) |
| Arrhythmia | 8 (6%) |
| Asthma | 7 (5%) |
| Cardiac arrest | 7 (5%) |
| Burns/inhalation | 6 (4%) |
| Pneumonia | 6 (4%) |
| Anaphylaxis | 5 (4%) |
| Diabetic Ketoacidosis | 4 (3%) |
| Croup | 3 (2%) |
| Sepsis | 3 (2%) |
| Meningococcaemia | 3 (2%) |
| Congenital heart disease | 2 (2%) |
| Procedure | 2 (2%) |
| Other | 12 (9%) |
In the prehospital phase, one of these children was intubated, three had an intraosseous needle inserted, and one was defibrillated. This has implications for prehospital training and skills maintenance. Similarly, 17 children (12%) were intubated in resuscitation; four of these were in cardiac arrest, and drugs were used in only 13. This equates to one child per month, and suggests that it would be difficult for emergency physicians to learn and maintain advanced paediatric airway skills, even in a children's hospital.
The database is easy to set up and use. We found it useful for audit and governance purposes. We would be happy to answer any enquiries, or supply a copy on request.
Footnotes
Funding: none.
Ethics approval was not thought necessary at the time of activity analysis. The data were already routinely collected as part of several hospital audits and the database was also designed to unify the collection process.
References
- 1.O'Sullivan I, M Clancy M, Benger J. A computerised log for the emergency department resuscitation room. Emerg Med J 200320568. [DOI] [PMC free article] [PubMed] [Google Scholar]