6705 ‘Under the radar’- epidemiological and clinical features of infant emergency department attendance for low acuity issues in a large district general hospital

Objectives Low acuity emergency department (ED) attendances among infants are known to be a significant issue,1 but granular data is lacking.2 We aim to present data on low acuity infant ED attendances and use a sample across acuity levels to examine clinical features of presentations at a busy London district general hospital. Methods Data for ED attendances aged 0–12 months were extracted from hospital electronic systems (SMISS and Symphony) from 01/01/2018 to 15/05/2023, including demographics, assigned acuity level, diagnosis and admission rates. Infants diagnosed as 'No abnormality detected' (NAD) and not admitted were categorised as low acuity attendances. A random sample of 100 ED attendances in 2022, equally distributed across 5 assigned acuity levels, were examined in more detail. Analysis including descriptive statistics, chi-squared test for trend and differences in proportions was undertaken in excel. Ethics approval was not required in line with HRA guidance. Results Of 21,319 ED attendances during the study period, 3286 (15.4%) were discharged with a diagnosis of NAD. There was a downward trend in proportion of NAD by year (p=0.016). NAD presentations were more likely to be female and of younger age compared with all ED presentations. The mean index of multiple deprivation decile among NAD attendances is 5.30, compared with 5.33 for all ED presentations. Both are lower (more deprived) than the national average (5.5). Details are shown in table 1. Of 100 randomly selected attendances across 5 assigned acuity levels (20 per acuity level), most were diagnosed NAD or upper respiratory tract infection; and discharged with no investigations or treatment. Frequent presentations among those discharged (all acuity levels) include noisy breathing (17), crying (10) and feeding concerns (8). Even among the 20 attendances assigned the highest acuity level, three were infants discharged home with NAD. Among infants assigned acuity 4 (low acuity) one required intubation and PICU, and 6 required intravenous medication and admission. Conclusion Attendances with 'NAD' represent a significant proportion of all infant ED attendances. Low acuity attendances were younger and more likely to be female than all infant ED attendances. Rates of NAD diagnoses decreased over time, although this may indicate alternate low acuity diagnoses replacing NAD. Detailed examination of attendances indicates poor correlation between assigned acuity and outcome, and frequent attendances of younger babies with minor ailments. A large proportion of these could be managed in primary care or by community services. References Alele FO, Emeto TI, Callander EJ, Watt K. Non-urgent paediatric emergency department presentation: A systematic review. Journal of Paediatrics and Child Health, 2019. Nath S, Zylbersztejn A, Viner RM, Cortina-Borja M, Lewis KM, Wijlaars L, et al. Determinants of accident and emergency attendances and emergency admissions in infants: birth cohort study. BMC Health Serv Res, 2022.