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Admissions following assault in children and young people
  1. T F Zerb,
  2. M E Ford-Adams
  1. Paediatrics, Kings College Hospital, London, UK

Abstract

Aims With frequent reports of knife and gun crime in the local area we aimed to determine the incidence of young people requiring admission to an inner city hospital following assault. We focused on safeguarding interventions performed during admission, as recommended on a safeguarding prompt list we had recently introduced. We also attempted to estimate the burden on resources of these admissions.

Methods Retrospective case-notes review of all patients ≤18 years admitted following an assault who presented to our Emergency Department in 6 months between December 2009 and May 2010.

Results 37 patients were identified, all male, ranging from 13 to 18 years. 78% were black, 11% white and 11% of other ethnicity. 81% of injuries were stabbings, 5% gunshot wounds and 14% other. 43% patients sustained multiple injuries. Social history was poorly documented with 11–35% recording previous assault, social services involvement, police involvement, child psychiatry, family history of violence, or poor school attendance, but only 3–16% recording definite negatives for these categories. Once admitted 53% were referred to the safeguarding team, 67% to social services, 77% to the youth worker, and 47% to child psychiatry. 90% had police involvement, 35% had their general practitioner contacted and 43% of school attendees had their school contacted. In 38% there was consideration of ward security. Incidence of these interventions was increased on paediatric wards compared to adult wards. The safeguarding prompt list, present in 19% of notes, increased safeguarding interventions further. Four patients self-discharged two of whom were later readmitted with new injuries. 24% required helicopter retrieval and 65% ambulance. Admission ranged from <1–42 days. 37 patients accounted for a total of 190 inpatient days, including 14 ITU and 18 HDU days. They required 65 separate specialty reviews and 31 surgical procedures. The estimated average admission cost was £4875.

Conclusions We observed a large number of significant injuries resulting in high cost admissions. Many patients did not have important safeguarding interventions performed. Safeguarding interventions occurred more frequently on paediatric wards and when the safeguarding prompt list was used. Recommendations include increasing safeguarding awareness and circulation of the safeguarding prompt list. Liaison with other agencies to follow-up patients could enable adaptation of safeguarding interventions to reduce further attendances.

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