Retrospective review of consecutive cases of paediatric complex pain in a New South Wales tertiary children's hospital.

Prior to July 2013, a solo medical specialist provided a pain management service 1.5-2 days/week to children and young people aged 0-19 years, and their families at John Hunter Children's Hospital, Newcastle, NSW. A new multidisciplinary children's complex pain team now continues that service. This study aimed to identify the demographic and clinical characteristics of children, young people and their families referred to a paediatric pain specialist in the 5.5 years prior to the establishment of a multidisciplinary service and to quantify anecdotal observations, determine service priorities and identify clinical improvement opportunities. A retrospective review of the medical records of all new patients seen between January 2008 and June 2013 was conducted. Data sets for patient demographics, clinical characteristics, service outputs and disposition at discharge were determined prior to data extraction. A total of 114 children and young people aged between 7 days and 18 years (mean ± SD = 12.54 ± 3.6 years) were consecutively referred to the service. Many demographics are consistent with those previously reported; however, the number of children who identified as being of Aboriginal origin (11%), with rare diseases (28%), new diagnoses made (47%), child protection reports submitted (14%) and psychological morbidity in children (58%) and caregivers (38%) are new findings in the context of pain management and serve as indicators of the complex service needs of these patients and their families. The complexities encountered in this small cohort provide an indication of the time investment needed to understand and manage complex paediatric pain, especially in the contexts of complex families, time-poor general practitioners and under-resourced communities.

Kepreotes EA ，Lord SM 《-》

Novel inpatient surveillance in tertiary paediatric hospitals in New South Wales illustrates impact of first-wave pandemic influenza A H1N1 (2009) and informs future health service planning.

To document the impact of pandemic influenza A H1N1 (2009) in New South Wales (NSW) children's hospitals. A novel surveillance system, Paediatric Active Enhanced Disease Surveillance (PAEDS), identified hospitalised children <15 years with laboratory-proven influenza (1 June-30 September 2009) in the three children's hospitals in NSW: Children's Hospital at Westmead (CHW), Sydney Children's Hospital, John Hunter Children's Hospital. Clinical characteristics, management and complications were documented, and at CHW comparison made with 2007 data. The 324 children identified represented 1802 hospital bed-days and 230 PICU bed-days. Most (73.1%) children had H1N1, one had an oseltamivir-resistant isolate. Median age was 2.5 years: 65% were <5 years. Although 80.9% had cough, 8.0% had no respiratory symptoms. Complications occurred in 34.6%, of whom 56% were previously healthy. Only 50% received antivirals. Forty children (12.3%) were admitted to PICU: one child with H1N1 died. At CHW, comparison between 2009 and 2007 showed nearly twice the total number of admissions (226 vs. 122) and PICU admissions (22 vs. 13), but no deaths either year. Vomiting was more frequent in 2009 than 2007 (38.5% vs. 13.1%; P = 0.0001) as were neurological complications (11.4% vs. 2.4%; P = 0.0027) but length of hospital and PICU stay were similar. PAEDS is a valuable surveillance tool that documented the impact of the H1N1 (2009) pandemic in NSW children's hospitals. High numbers of complications, often in previously well children, suggest an important role for early diagnosis, antiviral therapy and influenza vaccination. Observed regional differences identify areas potentially at greater risk in a subsequent wave.

Elliott EJ ，Zurynski YA ，Walls T ，Whitehead B ，Gilmour R ，Booy R ，Members of SWINet ... -  《-》

The Management of Complex Pain in Children Referred to a Pain Clinic at a Tertiary Children's Hospital in Australia.

Collins J ，Haynes N ，Klingberg H ，Nicholas H ，Pounder M ，Sandells R ... -  《-》

Significant reductions in tertiary hospital encounters and less travel for families after implementation of Paediatric Care Coordination in Australia.

Breen C ，Altman L ，Ging J ，Deverell M ，Woolfenden S ，Zurynski Y ... -  《BMC HEALTH SERVICES RESEARCH》

Inequalities in access to a tertiary children's chronic pain service: a cross-sectional study.

Poor health, including chronic pain, has been consistently shown to be associated with lower socioeconomic status (SES). To describe the SES of a clinical population of children with chronic pain referred to tertiary care in England, and to determine if access to, and utilisation of, the service is related to SES. Using a retrospective cross-sectional study design, all children referred to a tertiary chronic pain management service between 2000 and 2014 were included. SES was determined using the English Index of Multiple Deprivation for the area in which they lived. Distance from the study site, using Ordinance Survey National Grid coordinates, and service utilisation, from hospital records, were also calculated. 737 children were included. The proportion of patients referred from the most socially deprived areas was substantially lower (14%) than from the least deprived (25%). In addition, the proportion of patients from the most deprived areas fell with increasing distance from the study site. Patients from the most deprived areas were more likely not to attend hospital appointments. Contrary to expectations, there were fewer patients from the most deprived areas. The proportion of children from more deprived areas fell with increasing distance from the study site, and those children who were referred were less likely to attend scheduled appointments. Our results imply that there is a social gradient in access to tertiary services for children's chronic pain management.

Jay MA ，Howard RF 《-》