A clinical audit of the pre-hospital paediatric respiratory assessment in London

01 February 2014
Volume 6 · Issue 2


Assessing a child with difficulty in breathing is a challenge in a pre-hospital setting, especially children under 3 years old. Nevertheless, hypoxia must be treated early, and a respiratory assessment is essential to ensuring the well being of these patients. The aim of this audit was to update the research, as there have been changes in equipment and training since this was last addressed. A criterion-based clinical audit was undertaken of 253 patient report forms collected from the London Ambulance Service over a one-month period. The pre-hospital clinician must have coded dyspnoea (difficulty in breathing) and the patient's age must be under three years. The observations audited were: respiratory rate, auscultation attempt and oxygen saturations, any exceptions were noted. The results showed that 85% (n=220) had two respiratory rates recorded, 70% (n = 178) recorded an auscultation attempt, whilst two oxygen saturation recordings were documented for 52% (n=131). The main reason for no oxygen saturations was ‘no kit’, accounting for 38% (n= 45) of the non-compliance. Overall, 39% (n=99) recorded all three observations in this audit. It was concluded that there has been progress since the last review; however, there is still potential for better compliance. Recording oxygen saturations especially needs improving and the availability of equipment requires addressing.

Paediatric assessment is a challenging skill in the pre-hospital setting. Pre-hospital clinicians are generalists and do not have the specialised paediatric training that hospital and primary care clinicians will have. The fact remains, however, that demand for this skill is high. To take London as an example, 5% of all patients attended to by the London Ambulance Service NHS Trust (LAS) last year were under the age of four years (93 626 incidents). To put this in context, LAS clinicians attend more children under the age of four years than the sum of all patients in cardiac arrest, with confirmed myocardial infarctions and fast positive strokes. Paediatric patients are challenging to treat and it is therefore essential that clinicians are making appropriate, safe decisions based on their accurate clinical assessments.

Historically, studies suggest that confidence and aptitude amongst pre-hospital clinicians in assessing and treating paediatrics has been low. Research in the UK is sparse; however, American research has shown that pre-hospital clinicians are not confident treating paediatric patients and have the least confidence treating patients under two years old (Gausche et al, 1990). This lack of confidence may affect paediatric care as is evidenced by a UK study where pre-hospital clinicians have not adequately monitored or treated paediatric patients (Fisher and Vinci, 1995). This has been supported by more recent American research that reports pre-hospital clinicians have the lowest accuracy in assessing infants (Foltin et al, 2002). The research indicates that there is a potential to improve the assessment and treatment of this challenging age group.

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