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P126. UK inflammatory bowel disease (IBD) audit: inpatient data from paediatric patients with Crohn's disease

S.G. Mitton1, A. Protheroe2, M. Auth3, R.M. Beattie4, C.P. Charlton5, M. Elawad6, J. Fell7, M. Furman8, M. Green9, H. Jenkins10, D. Mitchell11, A. Thomas12, F. Torrente13, I. Arnott14, M. Roughton2, R.K. Russell15, 1St Georges University London, Child Health, London, United Kingdom, 2Royal College of Physicians, Clinical Effectiveness and Evaluation Unit, London, United Kingdom, 3Alder Hey Children's NHS Foundation Trust, paedaitric gastroenterology, Liverpool, United Kingdom, 4Southampton Children's Hospital, Paediatric Gastroenterology Unit, Southampton, United Kingdom, 5Nottingham Children's hospital, Paediatric Gastroenterology, Nottingham, United Kingdom, 6Great Ormand Street hospital, Gastroenterology, London, United Kingdom, 7Chelsea & Westminster hospital, Paediaitric Gastroenterology Unit, London, United Kingdom, 8Royal Free Hospital, Paediaitric Gastroenterology Unit, London, United Kingdom, 9Leicester Royal Infirmary Children's hospital, Paediatric Gastroenterology, Leicester, United Kingdom, 10University hospital of Wales, Child Health, Cardiff, United Kingdom, 11Sheffiled Childrens hospital, Paediatric Gastroenterology, Sheffield, United Kingdom, 12Royal Manchester Children's Hospital, Paediaitric Gastroenterology Unit, Manchester, United Kingdom, 13Addenbrooke's hospital, paed gastroenterology unit, Cambridge, United Kingdom, 14Western General Hospital, Gastroenterology, Edinburgh, United Kingdom, 15Yorkhill Hospital, Department of Paediatric Gastroenterology, Glasgow, United Kingdom

Background

The UK IBD audit aims to improve quality of care for all IBD patients in the UK. Data from paediatric IBD inpatients were entered into two audit rounds; in 2008 and 2010 which are described here for Crohn's disease (CD) inpatients.

Methods

Clinical details of inpatients with CD aged <17 years were entered by 23 UK paediatric centres into the audit from September 2010 to August 2011, including those admitted for surgery. Day case & 24hr admissions for diagnostic endoscopy were excluded. 20 of the 23 sites took part in both rounds, so only patients from these sites are compared across rounds. The rounds of audit are referred to as 2008 and 2010.

Results

695 patients with CD were admitted across the two rounds with 342 patients (217 males) median (IQ) age 13yrs (12–15) entered in the 2010 round. 92 (27%) were emergency and 72 (25%) planned, admissions for CD. 51 (15%) were admitted for elective surgery and 107 (31%) with a new diagnosis of CD. Median (IQ) length of stay was 5 (3–5) days; there were no deaths. Significant improvements seen across rounds (2008 v 2010 respectively) were; more non-elective patients saw an IBD nurse during admission 173/297 (58.3%) v 204/285 (71.6%) p = 0.001. Fewer patients had admissions in the 2 years prior to the audited admission 159/243 (65.4%) v 123/237 (51.9%) p = 0.003. More patients saw a dietician during admission 213/297 (72%) v 229/285 (80.4%) p = 0.015 and laparoscopic surgery increased in non elective admissions 3/34 (8.8%) v 10/28 (35.7%) p = 0.010. Non elective patients given anti TNF agents during admission increased from 3.5% (10/283) v 7.7% (20/261) p = 0.035. Areas for improvement: The number of stool samples sent for C Difficile from non elective admissions increased from 32/123 (26%) to 60/192 (31.3%) but not significantly and the numbers of patients over 12yrs asked about smoking habits did not change across rounds. New data in 2010 showed a very small number, 59/237 (25%), had pubertal status recorded in the year prior to admission and 1/342 (0.3%) experienced a thrombotic episode.

Conclusion

Care of paediatric CD inpatients across the two rounds improved with significant increases in those seeing an IBD nurse and dietician, falling readmission rates and an increase in laparoscopic surgery in non elective cases. However we need to collect stool samples for C. difficile, record pubertal stage and smoking status on all inpatients. We should develop a consensus guideline for antithrombotic prophylaxis across the UK for paediatric IBD inpatients.