428 Evaluation of the management of children with positive blood or urine cultures. (17th August 2022)

• Record Type: Journal Article
• Authors: Guanzon, Joy; Swallow, Florence; Dawson, Tom
• Is Part Of: Archives of disease in childhood. Volume 107(2022)Supplement 2
• Page Start: A105
• Page End: A105
• Publication Date: 2022-08-17
• Subjects: Children -- Diseases -- Periodicals; Infants -- Diseases -- Periodicals; 618.920005
• DOI: 10.1136/archdischild-2022-rcpch.170
• Languages: English
• ISSNs: 0003-9888

Abstract

Abstract : Aims: 1. To recognise the most common presenting signs and symptoms of patients 2. To recognise the most common time of the day and the month they present 3. To assess how medical team quickly reviewed them and gave treatment 4.To see how many patients did not get a senior doctor review within 1 hour during the months of September to December Methods: Retrospective, descriptive notes study Paediatric patients in Worcester Royal hospital from April 2018 - March 2019 Total of 89 patients with positive blood or urine cultures who had complete details in the electronic (EZ) notes were analysed Results: Fever was the most common of presenting signs and symptoms accounting for 53.9% patients followed by abdominal pain (13.5%), lethargy (12.4%), rash (10.1%), vomiting (10.1%), decreased oral intake (10.1%) and seizures (6.7%). Other signs and symptoms accounted less than 5%. Among these patients with positive cultures, 32 triggered sepsis. Fifty four patients came between 16:00 and midnight which is more than doubled the number of those who came in between 08:00 and 16:00 (24). After midnight to before 08:00 has the least number of admissions. Most of the admissions occurred during the autumn to winter months, with November as the highest with13 patients. March and August has the least number of admissions with 3 and 4 respectively. Thirty eight of patients were reviewed by the registrar or consultant within 1 hour of admission. A total of 35 patients were reviewed >1 hour but <4 hours. Eleven were not reviewed within the 4 hours period. There were 4 who patients did not have the time of review documented in their notes. 53.8% of the patients who were not reviewed by a senior doctor within 1 hour and were admitted during September to December. Sixty five of the patients had positive urine cultures while 25% had positive blood cultures. 3% of the patients had grown a pathogen for both. Among those with positive blood culture, 57% were considered contaminant. Out of the 89 subjects, 13 were oncology patients. All oncology patients received their treatment on time, however only just under a quarter had a senior review within 1 hour. Conclusion: Majority of the patients presented with fever, abdominal pain and lethargy. They presented mostly during the twilight time in autumn and winter periods. Less than half of the patients were reviewed within 1 hour. They had more chances of not being reviewed on time if they are admitted during autumn to winter time. Most blood culture pathogens were considered contaminant. All oncology patients received timely treatment on admission despite only a few had a timely senior review.