Aims To establish trends in diagnoses in pre-school children admitted to a large urban hospital over a 10 year period with respiratory symptoms. To explore the feasibility of developing a baseline for time trend analysis with the objective of assessing the effects of service innovations designed to improve quality of care for children with asthma and allergy.

Methods We analysed routine data in-patient attendances to the hospital between 2004 and 2013. We included all children under 5 years old where there was coding of diagnosis on discharge. Descriptive analysis of the top 5 diagnoses over 10 years.

Results There were 12,601 admissions of children under 5 years old in the study period which accounted for 60.5% of the total admissions of children under 15 years old. Acute upper respiratory infection, acute bronchiolitis, and asthma were consistently the top 3 diagnoses in 9 out of the 10 years in this age group; over half of the diagnoses (mean 51.2%, sd 7.9, [40.3–63.3%]). Acute upper respiratory infection was the leading diagnosis in 8 out of the 10 years and ranged from 41.6% (2004) to 13.1% (2013). There was a relative reduction in the proportion of children diagnosed with URTis over this time with an increase in other categories (Figure 1). The majority of admissions were less than 1.6 days.

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Abstract G345(P) Figure 1

Graph showing trends in respiratory diagnoses over 10 years (%)

Conclusion Acute respiratory infection has been consistently the main primary diagnosis of pre-school children admitted on to our wards. The increase in “asthma” might suggest possible systematic diagnostic coding differences during this time period or a true increase in prevalence in this age group as has been described¹. Accurate baseline data is essential especially for this age group where a diagnosis of asthma may vary considerably between practitioners and over time. Adherence to recent guidelines on accurate diagnosis in preschoolers² and appropriate staff training of clinicians and clinical coders may help to refine this further.

References

1. Radhakrishnan D, Dell S, Guttmann A, Shariff S, Liu K, To T. Trends in the age of diagnosis of childhood asthma. J Allergy Clin Immunol 2014; 134(5):1057–62.e5

2. Saglani S, Bush A. Asthma in preschool children: the next challenge. Curr Opin Allergy Clin Immunol 2009; 9:141–5