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Re: Children with pneumonia: short stay assessment facilities lower admission rate

Dear Editor,

I read with great interest the article by Clark et al1 which described the spectrum of clinical features and management of community acquired paediatric pneumonia in the UK. The patients were children (0-15 years) with radiologically-proven pneumonia who presented to hospitals in the North East of England between August 2001 and July 2002. Children were excluded if there was a clinical diagnosis of bronchiolitis, if they had been in hospital in the preceding 3 weeks or if their main place of residence was not within the Region. I shared the authors’ surprise at the admission rate (89%) which seems very high in comparison to practice in the hospital where I work. Local audit using the same inclusion & exclusion criteria as above identified 47 children with community acquired pneumonia presenting over the 5 month period 1st January – 31st May 2007. All of the children were assessed in our Paediatric Short Stay Assessment Unit and the decision about whether to admit or discharge was taken after a period of observation (median length 4.8 hours). Just 57% (n=27) were admitted to hospital; the rest (n=20) were discharged home with oral antibiotics and 6 of these children had reviews arranged for 3 - 7 days later. All discharged children were given “open access” to the Unit (their parents could call the Unit directly at any time for advice or to request review) but only 1 family used this service. These data lend support to previous evidence2 that short stay facilities reduce paediatric admission rates and, since we all appreciate that children are best managed at home whenever possible, I would be very interested to learn about the availability of short stay facilities in the Paediatric Units included in Clark’s review.

Competing interests: None declared

References:

1. Clark JE, Hammal D, Spencer D, et al. Children with pneumonia: how do they present and how are they managed? Arch Dis Child 2007;92:394-398.