Article Text

PDF
Implementation of an evidence based guideline reduces blood tests and length of stay for the limping child in a paediatric emergency department
  1. Peter J McCanny1,2,
  2. Siobhan McCoy1,2,
  3. Tim Grant3,
  4. Sean Walsh1,2,
  5. Ronan O'Sullivan1,2
  1. 1Paediatric Emergency Research Unit (PERU), Department of Emergency Medicine, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland
  2. 2National Children's Research Centre and Department of Paediatrics, University College Dublin, Dublin, Ireland
  3. 3Centre for Support and Training of Analysis and Research University College Dublin, Dublin, Ireland
  1. Correspondence to Professor R O'Sullivan, Paediatric Emergency Research Unit (PERU), Department of Emergency Medicine, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland; ronan.osullivan{at}olchc.ie

Abstract

Introduction Acute non-traumatic limp is a common reason for children to present to the emergency department (ED). There is a wide differential diagnosis for these patients, and there are certain serious conditions which cannot be missed. An evidence based guideline for the ‘limping child’ was designed and the impact of guideline implementation on a number of specific, predefined quantitative outcomes was assessed.

Methods An initial retrospective chart review over 3 months was carried out for all patients presenting with acute non-traumatic limp. Following guideline introduction and implementation, information was gathered prospectively for a further 3 month period. Data outcomes between the two patient groups were then compared.

Results 110 patients met the criteria for inclusion: 56 pre-guideline and 54 post-guideline implementation. Baseline characteristics and diagnosis breakdown were similar in both groups. The rate of laboratory investigations was significantly reduced following guideline implementation (68% of patients pre-guideline, vs 48% post-guideline; (χ2), p=0.03). The number of x-rays carried out was similar in each group (74 pre- vs 67 post-guideline, mean 1.32 vs 1.28; (χ2), p=0.53). Length of time spent in the ED was significantly reduced following guideline implementation (median time 150 min pre- vs 82.5 min post-guideline; (χ2), p=0.04). No cases of serious pathology were missed using the guideline.

Conclusion Implementation of an evidence based clinical practice guideline for the limping child in a paediatric ED reduced the overall time patients spent in the ED, reduced the need for unnecessary laboratory investigations and ensured that appropriate investigations were carried out on an individual patient basis.

Statistics from Altmetric.com

Footnotes

  • Competing interests None.

  • Ethics approval The study was approved by the institutional research ethics committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.