Feasibility of single question mental health surveillance in chronic diseaseWhite, Mary; Pelly, Rachel; Le, Jane; Dove, Lucy; Connolly, Sarah; Morgan, Alice; Reid, Dave; Haslam, Ric; Hiscock, Harriet
doi: 10.1136/archdischild-2022-324000pmid: 35680403
ObjectiveTo determine the (1) feasibility and acceptability of administering single question mental health surveillance to carers of children with chronic disease in the inpatient setting and (2) sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of this question to detect ‘at risk’ children compared with the Strengths and Difficulties Questionnaire (SDQ).DesignCross-sectional pilotSettingDay Medical Unit of a tertiary paediatric hospital, 1 April 2021–31 July 2021.PatientsCarers of children aged 2–17 years with chronic medical conditions.InterventionsCaregivers were asked to respond to ‘Thinking about your child’s mental health over the past 4 weeks, are they thriving/coping/struggling/always overwhelmed?’ during the admission process. All carers and children 11–17 years were invited to complete the SDQ.Main outcome measuresFeasibility and acceptability were determined by nursing feedback. Sensitivity, specificity, PPV and NPV were determined by comparing question responses with clinical cut-points on the SDQ.Results213 carers responded to the question. Nurses reported that the question was easy (12/14) or moderately easy (2/14) to use and was ‘easily understood’ (6/14) or ‘understood after some explanation’ (8/14) for most carers. The question demonstrated a high specificity (0.98)/PPV (0.87) but low sensitivity (0.2) when thriving/coping were considered together whereas when thriving was compared with all other responses the sensitivity increased to 0.7.ConclusionsSingle question mental health surveillance appears acceptable to carers and nursing staff and has a high level of specificity for children who are ‘struggling’ or ‘always overwhelmed’ versus the SDQ screening measure.
Meta-analysis of donor–recipient gender profile in paediatric living donor liver transplantationWong, Zhen Yu; Low, Zhi Rong; Chen, Yong; Danaee, Mahmoud; Nah, Shireen Anne
doi: 10.1136/archdischild-2022-323892pmid: 35676083
ObjectivePaediatric living donor liver transplantation (LDLT) has gained popularity due to limited deceased donor organ supply. Some studies report inequalities in donor and recipient gender profiles, but data are sparse. We evaluated LDLT donor–recipient gender profiles, comparing country income categories and gender disparity level.DesignWe performed a systematic review, searching PubMed, Embase and Cochrane databases for publications dated January 2006–September 2021. We included full-text English articles reporting gender in ≥40 universally sampled donor–recipient pairs. Search terms were permutations of ‘liver transplant’, ‘living donor’ and ‘paediatric’. Countries were grouped as high/middle/low-income economies based on World Bank criteria and into groups based on deviation from gender parity in Gender Development Index (GDI) values (group 1 indicating closest to gender parity, group 5 indicating furthest). Proportions analysis with corresponding 95% CI were used for analysis of dichotomous variables, with significance when 95% CI did not cross 0.5. Data are reported as female proportion (%) and 95% CI.ResultsOf 12 525 studies identified, 14 retrospective studies (12 countries; 6152 recipients and 6138 donors) fulfilled study inclusion criteria. Male recipient preponderance was seen in lower middle-income countries (all were also GDI group 5) (39.3 (95% CI 34.7 to 44.0)) and female recipient preponderance in GDI groups 1 and 3. Female donor preponderance was seen overall (57.4% (95% CI 55.1 to 59.6)), in middle income countries and in three of four GDI groups represented.ConclusionThere are significant imbalances in recipient-donor gender profiles in paediatric LDLT that are not well explained. The reasons for overall female donor preponderance across income tiers must be scrutinised.
Local nitroglycerin to facilitate peripheral arterial cannulation in children: systematic review and meta-analysisWagh, Deepika; Pawale, Dinesh; Tan, Jason Khay Ghim; Rao, Shripada C
doi: 10.1136/archdischild-2021-323757pmid: 35595521
BackgroundNeonates and children admitted to intensive care units require peripheral arterial cannulation to monitor their blood pressures and for blood sampling, but many times it is unsuccessful.ObjectiveTo conduct a systematic review and meta-analysis to evaluate the efficacy and safety of local nitroglycerin (NTG) to facilitate peripheral artery cannulation in neonates and children.Review methodsPubMed, EMBASE, CINAHL, Emcare and Cochrane library were searched till August 2021. Grey literature was searched through Mednar. Data were extracted by two reviewers independently using a prespecified form and the risk of bias was assessed. Meta-analysis was conducted using a random-effects model. The I2 statistic was used to quantify statistical heterogeneity. Certainty of evidence was assessed using the criteria of inconsistency, imprecision, indirectness, publication bias and size of effect as per the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) guidelines.ResultsTwo randomised controlled trials (RCTs) were included in this meta-analysis (n=153). One was conducted in children 2–8 years of age and the other was in children <2 years. Both trials found increased success rates with the use of local NTG. Pooling of the two studies found that the first-attempt success rate was significantly higher in the NTG group (risk difference: 0.44, 95% CI 0.05 to 0.83; I2=89%). Overall procedure time was significantly lower in the NTG group (mean difference: −100.28 s, 95% CI −136.74 to –63.82; I2=0%). No major complications secondary to the use of NTG were noted. The GRADE of evidence was very low.ConclusionLocal NTG may be useful in facilitating peripheral arterial cannulation in children. Adequately powered RCTs are needed to confirm these findings.
Impact of COVID-19 pandemic on emergency department attendances for young peopleSolanke, Folasade; Easton, Stephanie; Selby, Anna; James, David; Roberts, Graham
doi: 10.1136/archdischild-2021-323389pmid: 35551049
IntroductionThere are concerns that the COVID-19 pandemic is having an indirect negative impact on young people. We aimed to assess the impact of the pandemic on emergency department (ED) presentations and admissions.DesignWe analysed ED presentations and admissions from a 5-year period (April 2016–February 2021). An interrupted time series analysis was used to estimate the presentations and admissions that would have been seen in year 5 without the pandemic using the data from years 1 to 4. These estimations were used to calculate the difference between the expected and the observed presentations and admissions during the pandemic year.ResultsThere were 166 459 presentations over 5 years. There was a 38.1% (95% CI 33.9% to 42.3%) reduction in presentations during the pandemic with no variation by sex, age, deprivation or ethnicity. Largest reductions were associated with children being home schooled rather than with lockdowns. For admissions, there was a 23.4% (17.4% to 29.4%) reduction, less for 5–17 year age group. Infection and asthma/wheeze presentations reduced by around 60% with smaller reductions for mental health and trauma. There was no change for surgical presentations, burns/scolds or allergic reactions. There was an increase in females aged 11–17 years presenting with mental health issues during the pandemic.ConclusionsDuring the pandemic, there was a substantial reduction in both ED presentations and admissions. The differential impact on specific presentations suggests this was due to the impact of social distancing and reduced social mixing rather than widening of health inequality or increased barriers to care.Trial registration numberNCT04893122.