Hospitals under pressure from rise in admissions of kids with infections

The number of children admitted to hospital as emergencies has steadily increased every year since 2003, with the largest rises seen among the under 5s, an Oxford University study has found.

'The rise in admissions is likely increasing pressure on emergency services and hospitals to manage these cases,' says lead author Peter Gill, a doctoral student in the Department of Primary Care Health Sciences at Oxford University.

Emergency admissions rate among children rose by 28% between 1999 and 2010, from 63 per 1000 children to 81 per 1000. Two thirds of admissions to hospital in 2010, the most recent year with data, were for children under 5.

The greatest increase was among the under 5s, with admissions among children under 12 months increasing by 52% and those for children aged 1 to 4 rising by 25%. The findings are published in the journal Archives of Disease in Childhood.

The researchers say there could be a number of reasons for the rise, including changes to the family doctors' contract in 2004, which allowed GPs to opt out of providing out-of-hours care; and the four-hour wait target in emergency departments, which may have led to more admissions.

'It is difficult to say with certainty why these emergency admissions are rising,' says Peter Gill, as it is likely to reflect changes that have taken place in the hospital sector, in parental attitudes and in primary care. 'However, our findings suggest the threshold for hospital admission has lowered and there may be an increased reluctance by parents and doctors to tolerate uncertainty,' he says.

Common infections account for much of the rise in admissions, many of which could have been managed in the community and probably did not need hospital treatment, say the researchers. They suggest this indicates a 'systematic failure in the NHS' to assess children with acute illness that could be better managed by family doctors, out-of-hours services, and the NHS Direct telephone advice service, rather than hospitals.

Peter Gill explains that the increase in hospital admissions does not reflect an increase in number of severe infections among children, because most of the admissions were short same-day admissions. The number of deaths among children aged 1-14 also fell 36% between 1999 and 2010 in England and Wales.

Projected population increases suggest that by 2020, some 731,000 under 5s will be admitted as emergencies on the basis of current trends. That’s 230,000 more than at present, say the researchers.

'We suggest that there needs to be restructuring of the way acute paediatric care is delivered, particularly emergency and out-of-hours care,' says Peter Gill. He says effective strategies that bring together GP and hospital care are needed, and strategies that are piloted before they are implemented.