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The management of atopic eczema by general paediatricians in a district general hospital
  1. C V de Silva1,2,
  2. J H M Rees1
  1. 1General Paediatrics, Royal Shrewsbury Hospital, Shrewsbury, UK
  2. 2General Paediatrics, University Hospital North Staffordshire, Stoke-On-Trent, UK

Abstract

Aims To assess adherence to the 2007 National Institute of Clinical Excellence (NICE) standards of assessment, advice and treatment of atopic eczema in children under 12 years in a general paediatric department,1 specifically with regards to information given to the child and family; assessment of the extent, severity and triggers of eczema; and the appropriateness of treatment and dermatological referral.

Methods Children under 12 years with eczema treated by a paediatrician between 1 January and 31 December 2008 were identified via pharmacy prescriptions and computer records. Casenote review was undertaken and data were collated using the NICE 2007 audit tool over a 3-month period in 2009–2010.

Results 62 children were identified, alternate case notes (31) were requested. Of 25 sets obtained, 4 had an alternative diagnosis and were excluded. Of the sample of 21 children (11 boys, 10 girls), 12 children were under 3 year old. Four children had no record of assessment or treatment of their eczema. All 17 remaining children had some assessment of eczema severity and were prescribed emollients; seven had some assessment of triggers. 7 children had mild eczema, 10 had moderate, and 2 had severe eczema (groups not mutually exclusive). 14 children were told how often to use treatments, and 9 were told how much to use. Four children were given advice about stepping treatment up or down; none were told how to recognise flares or infected eczema. 6 of 10 children with moderate eczema were given appropriately potent steroids. one of two children with a severe flare was treated with mild potency corticosteroids. All six dermatological referrals were appropriate.

Conclusions Description of eczema was good but often not holistic. Severity of eczema was often not correctly identified with a subsequent tendency to undertreat. Areas of poor performance included choosing the correct potency and duration of steroid treatment, and giving information about flares, infection and eczema herpeticum. Prescription of emollients and dermatological referral was appropriate. Paediatricians need better support with managing this common condition. Changes recommended included (1) use of a patient information leaflet including a stepped eczema management plan, and (2) a proforma for use in clinic to bring practice in line with NICE recommendations.

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