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NRAD and Children
What the Report Means for
Paediatric Care
Dr. James Paton
University of Glasgow,
Clinical Audit Lead, RCPCH
6th May 2014
28 Children and Young People
Died of Asthma
Age 4 – 19 yrs
Age Group
<10 yrs
10 – 19 yrs
10 (5%)
18 (9%)
20 – 44yrs
33 (17%)
45 – 64yrs
50 (26%)
65 – 74yrs
35 (18%)
75 +
47 (24%)
Many Children Died Before
Reaching Hospital
8/10 (80%) children <10 yrs
13/18 (72%) children 10-19 yrs
Even Those With Mild/ Moderate
Asthma Were At Risk
Age Group
Asthma
12/28
were
Severity(42%) of children
<10 yearswho died10
- 19yrs
thought
to have0mild /0%
moderate1 asthma 6%
Mild
Moderate
Severe
3
6
30%
60%
8
7
44%
39%
Not Known
1
10%
2
11%
Total
10
100%
18
100%
How Did the Children Die?
Only 4 / 28 “Asthma
(14%) children
had a record of
Attacks”
being provided with an Asthma Action Plan
-
How to spot when symptoms are getting worse
What to do when symptoms worsen
What to do in an emergency
When to call for emergency help
Targeting Lung Attacks
Fitzgerald Thorax 2011;66: 365-66
Avoidable Factors – Families &
Environment
Under 10yrs
10 - 19yrs
One or More Avoidable Factors
9 (90%)
17 (94%)
Poor Adherence to Medical Advice
9 (90%)
13 (72%)
- Failure to Take Appropriate
Medications
4 (40%)
13 (72%)
Psychosocial factors
3 (30%)
4 (22%)
Passive smoke exposure
3 (30%)
7 (39%)
Allergy
- Animals
- Food allergy
- Seasonal
2 (20%)
0 (0%)
0 (0%)
2 (20%)
7 (39%)
2 (11%)
2 (11%)
6 (33%)
Factors
Adherence Matters!
• ICS Adherence >80% was associated with
better asthma control
• Children with persistent mild symptoms had
lower ICS adherence rates (p = .028)
ERJ 2014; 43: 783-91
Daily Hospital Admissions for Asthma among
Children between 2000 and 2009 in Scotland
Mackay et al N Engl J Med 2010; 363:1139-1145
Avoidable Factors – Ongoing
Medical Care/Supervision
Factors
<10yrs
N (%)
10 - 19yrs
N (%)
1ry
2ry
1ry
2ry
One or More Avoidable
Factors
8 (80)
4 (57)
16 (89)
4 (44)
- Did Not Check Inhaler
Technique
3 (30)
2 (29)
2 (11)
2 (22)
- Did Not Identify Triggers
0 (0)
1 (14)
6 (33)
2 (22)
Asthma Deaths and Time of Year
Quality of Care – Panel Conclusions
Conclusion
All ages
(195)
0-19
(28)
Chronic Management
- Adequate
56 (29%)
2 (7%)
Previous Attack Management
- Adequate
69 (35%)
8 (29%)*
Final Attack Management
- Adequate
66 (34%)
13 (46%)*
Overall Standard of Asthma Care
- Good practice
31 (16%)
1 (4%)
Trends in Childhood Asthma
Deaths Have Been Downwards
But Children with Asthma Are Still
Dying
2012 – 17 CF deaths in children <20 yrs1
2012 – 28 Asthma deaths in children <20yrs
1UK
Cystic Fibrosis Registry
Annual data report 2012
What Does the Report Mean for
Paediatric Care?
1. Always remember – children die of asthma – “Asthma
Attacks” can kill
2. Everyone should have an asthma action plan
3. Good adherence can be achieved, and does matter
4. Passive smoking is bad for children with asthma
5. Do not forget psychosocial factors & asthma triggers
6. Meticulous attention to asthma guidelines will save
lives
NRAD Confidential Enquiry Panels
Expertise
No.
Paediatricians (general, respiratory, allergy, intensive care and
emergency care)
21
Adult physicians (general, respiratory, allergy, intensive care and
emergency
67
General Practitioners
34
Pharmacists
2
Primary care nurses (specialist asthma and respiratory)
25
Secondary care nurses (consultants, paediatric nurses, specialist
adult and paediatric asthma and respiratory nurses )
24
Clinical Lecturers
1
Total
174
Coding Accuracy - Panel vs Coding