Are routine investigations in acute paediatric admissions justified?

Abstract

Aim: To assess the appropriateness of investigations and their impact on management of acute paediatric admissions. Method: All investigations performed within the first six hours in all consecutive paediatric admissions (n=138) over a 6 week period, in a teaching general hospital, were recorded retrospectively and the results were analysed for normality/ abnormality and effect on patient management. Results: Out of a total of 480 emergency investigations performed on 89 patients, the complete blood count, electrolytes and chest X-rays were the three investigations most likely to be deranged and influenced management in 5% (n=3), 25% (n=8) and 46% (n=6) of subjects with an abnormal result, respectively. Impact on management was more evident on analysing a subgroup admitted with mild gastroenteritis, in whom serum electrolytes were abnormal in 50% (n=19), and 42% (n=8) of these needed a change in their management. Conclusion: Rationalising the number of investigations in acute paediatric admissions would result in less discomfort to children and in a significant cost benefit.